Racial Differences in Prostate Cancer Treatment
By: Olutiwa A. Akinsola, MD; Kelvin A. Moses, MD, PhD, FACS | Posted on: 01 Apr 2022
Racial disparities exist in every facet of our society, and medicine is far from an exception. Within oncology, we have seen that Black Americans have the highest death rate and shortest survival of any racial/ethnic group in the United States for nearly all cancers.1 Dr. LaSalle Leffall was one of the first to highlight this when he published the seminal paper “Alarming Increase in Cancer Mortality in the US Black Population” in 1973, in which he hypothesized that environmental factors, and not race, were likely the cause of this difference.2 It is not the genetic differences between races that drive different health outcomes, but the impact of the social and environmental constructs of race on our society.
Within the field of urological oncology, we continue to see differences in treatment received by Black men with prostate cancer compared to White men, and there are ample data showing that these differences in treatment are the primary driver for the variations we see in mortality. Underwood et al were among the first to show that Black and Hispanic men were less likely to receive definitive therapy when compared to White men.3 Some groups have hypothesized that this difference was due to Black men being more likely to have a higher stage of prostate cancer upon presentation in comparison to White and Hispanic men.4 In an answer to this hypothesis, Moses and colleagues found when comparing Black and White men with similar disease characteristics, Black men are more likely to receive no therapy at all or nonsurgical therapy for prostate cancer in comparison to White men.5
Simply knowing that these disparities exist is not enough–it is time to enact productive change in order to combat these inequities. Concrete measures that our field could employ to tackle inequities in cancer treatment have been described in detail.6 Improving access for underrepresented patients, increasing diversity within the field and improving cultural competency all tackle different deficient areas that have the potential to improve outcomes for our patients. The issue of access was also discussed by Carthon et al, who noted multiple studies have shown that Black men treated within the VA have similar outcomes to White men.7 This group also showed how community-based education on prostate cancer is a way to improve shareddecision making on screening and treatment. Increasing the number of practitioners of color in the predominately White field of urology can help to improve outcomes for all patients; a systematic review by Shen et al showed that racial concordance for Black patients improved aspects of communication during patient-provider interactions. Lastly, increasing cultural competency within our institutions can help identify our implicit biases, learn how these preconceptions affect our treatment of patients and find ways to combat these biases.
Much of the work has been done to further elucidate the racial disparities that exist within the field of urology and medicine as a whole. Now, the work comes down to enacting different ways to combat these disparities with the goal to ensure all patients, no matter their race, receive optimal care.
- American Cancer Society: Cancer disparities research highlights. 2022. Available at https://www.cancer.org/research/acs-research-highlights/cancer-health-disparities-research.html#. Accessed February 8, 2022.
- Henschke UK, Leffall LD Jr, Mason CH et al: Alarming increase of the cancer mortality in the U.S. Black population (1950–1967). Cancer 1973; 31: 763.
- Underwood W, De Monner S, Ubel P et al: Racial/ethnic disparities in the treatment of localized/regional prostate cancer. J Urol 2004; 171: 1504.
- Latini DM, Elkin EP, Cooperberg MR et al: Differences in clinical characteristics and disease-free survival for Latino, African American, and non-Latino White men with localized prostate cancer: data from CaPSURE. Cancer 2006; 106: 789.
- Moses KA, Paciorek AT, Penson DF et al: Impact of ethnicity on primary treatment choice and mortality in men with prostate cancer: data from CaPSURE. J Clin Oncol 2010; 28: 1069.
- Moses KA, Orom H, Brasel A et al: Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer. Urol Oncol 2016; 34: 415.e7.
- Carthon B, Sibold HC, Blee S et al: Prostate cancer: community education and disparities in diagnosis and treatment. Oncologist 2021; 26: 537.