Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

Abstract

Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exists among Black men in this country. This primary objective of this systematic review is to describe the reported disparities in screening, diagnostics and treatments as well as efforts to alleviate these disparities though community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, sub-analyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal access care environments have shown similar outcomes. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. The Oncologist 2021;9999:• • Implications for Practice: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher PSA, and other adverse factors, but outcomes can be attenuated in trials or in equal access care environments. Recent data has shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities. BACKGROUND Despite notable progress over the years, prostate cancer remains the leading cancer among men in the United States, with 191,000 cases and 33,000 deaths anticipated in 2020 1. Advances in screening rates, genomic testing, imaging, and treatment have led to an almost 98% five-year survival among affected men 2. Black men, however, have traditionally had higher incidence and decreased rates of survival in prostate cancer for all stages. Statistically, 1 in 9 men overall and 1 in 7 Black men will be affected 3. Moreover, Black men are more likely to be diagnosed at an earlier age, have advanced disease at that time of diagnosis and have significantly elevated PSA levels compared to White men 3-6. They also have a higher risk of regional and metastatic disease at presentation 7,8. Several factors could possibly account for this higher relative incidence and poorer outcomes for Black men with prostate cancer. Patients with lower socioeconomic status and less education have been shown to have worse overall survival from prostate and other ...

Landmark Cancer Clinical Trials and Real-World Patient Populations: Examining Race and Age Reporting

“…Even for the National Cancer Institute’s (NCI) clinical trials, less than 2% had a focus on the racial/minority population as their primary emphasis [ 28 ]. Other interventions include incorporating enhanced models of patient navigation, and community partnership may be beneficial to overcome this minority accrual disparity [ 32 ]. Strategies such as video-based education have also been effective in the clinical trial setting for improving enrollment of minorities [ 33 , 34 ].…”

An important step towards smarter screening for prostate cancer

“…The authors do not report the uptake of the invitation across different parts of the community. However, current data shows that black men, who are at increased risk of prostate cancer, may be less likely to take up an invitation for prostate cancer screening 8 . A combination of interventions may be appropriate to increase uptake 9 , and the potential increase in acceptability in removing the need for digital rectal examination seems likely to contribute to a willingness to be screened across many communities.…”

Current prostate cancer screening and treatment strategies may not support a holistic nationwide program

“…For instance, studies conducted in the United States have identified factors such as access to Medicare (a national health insurance program) and private health insurance status, trial inclusion, and educational level as major barriers to prostate cancer screening. 39,44,45 In addition, individuals currently incarcerated are likely to experience discrimination in using the health care system and unequal access to cancer screening. 46 Because of the diverse nature of the UK population, factors such as low health literacy, culture, language, low screening uptake in individuals with mental illness, and low income have been identified as the major Cancer August 1, 2022 barriers to cancer screening.…”

“…However, several factors why men at high risk of developing prostate cancer are not being identified for treatment also come into play. For instance, studies conducted in the United States have identified factors such as access to Medicare (a national health insurance program) and private health insurance status, trial inclusion, and educational level as major barriers to prostate cancer screening 39,44,45 . In addition, individuals currently incarcerated are likely to experience discrimination in using the health care system and unequal access to cancer screening 46 .…”

“…Lifestyle factors that increase the incidence of prostate cancer are more common in Black minority ethnic groups 39 . Even though a significant number of early cancer diagnoses are being made, existing prostate cancer screening strategies do not account for individuals of lower socioeconomic groups: those with low health literacy, mental illness, and low income 39 .…”