Nature versus Nurture: Investigating Racial Disparity in Advanced Prostate Cancer

Abstract

Considering recently published studies, this commentary addresses racial inequality in cancer care for patients with prostate cancer.

Disparities With Systemic Therapies for Black Men Having Advanced Prostate Cancer: Where Do We Stand?

“…47 Finally, it has been argued that potential biological differences between Black and White men with metastatic prostate cancer need to be accounted for in assessing racial disparities that remain in the advanced disease setting. 43 A discussion of biological drivers of prostate cancer disparities between Black and White men is beyond the scope of this review but has been reviewed elsewhere. 43,[48][49][50] We will end this review with a discussion of access-related disparities that need to be considered when addressing differences in outcomes in systemic therapy for Black men with metastatic prostate cancer.…”

“…43 A discussion of biological drivers of prostate cancer disparities between Black and White men is beyond the scope of this review but has been reviewed elsewhere. 43,[48][49][50] We will end this review with a discussion of access-related disparities that need to be considered when addressing differences in outcomes in systemic therapy for Black men with metastatic prostate cancer. Specifically, we will focus on access to systemic therapy topics related to treatment initiation, choice of initial systemic therapy, sequencing and subsequent lines of therapy, and the need for more diverse clinical trial participation.…”

“…Discordant results in systemic therapy outcomes for Black and White men with advanced prostate cancer may be dependent on the use of population-based epidemiologic outcomes data that is heavily influenced by SES versus using patient-level data that may better control for these variables. 43 This was one of the reasons we structured our review on the basis of real-world registry data and prospective data (Tables 1 and 2). Theoretically, prospective clinical trials and retrospective data from equal-access health systems such as the VA reflect populations of Black men with equivalent access to systemic therapies, while real-world registries may not reflect a study population with equal access to prostate cancer care.…”

“…47 Finally, it has been argued that potential biological differences between Black and White men with metastatic prostate cancer need to be accounted for in assessing racial disparities that remain in the advanced disease setting. 43 A discussion of biological drivers of prostate cancer disparities between Black and White men is beyond the scope of this review but has been reviewed elsewhere. 43,48-50…”

“…43 A discussion of biological drivers of prostate cancer disparities between Black and White men is beyond the scope of this review but has been reviewed elsewhere. 43,48-50…”