PROSTATE CANCER Reaching for Health Equity in Prostate Cancer Care Through Advocacy

By: Larissa Bresler, MD, DABMA, Loyola University Chicago Stritch School of Medicine, and Hines VA Hospital, Illinois; KiAundra L. Kilpatrick, BS, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; Kevin Koo, MD, MPH, MPhil, Mayo Clinic, Rochester, Minnesota | Posted on: 07 Sep 2023

Prostatic cancer remains a prevalent condition with broad impact in US men. The American Cancer Society estimates that in 2022 there were approximately 268,490 new cases of prostate cancer and approximately 34,500 deaths caused by prostate cancer in the United States. Globally, a total of 1,414,259 new cases of prostate cancer and 375,304 related deaths were reported in 2020. However, the burden of this disease is not shared equally across the population. Health inequities in prostate cancer care have been well established along the entire continuum of this disease: from screening and early detection to treatment outcomes and cancer survivorship.1,2

The drivers of racial and socioeconomic health disparities in prostate cancer screening, diagnosis, treatments, and outcomes are multifactorial and complex and have been expertly summarized in several recent articles, such as Lillard et al.3 Understanding and reducing these disparities require an integrated approach, from clinical care to public policy. One of the strategies to attain health equity in prostate cancer care is through legislative and regulatory advocacy. This is where the missions of the AUA Diversity, Equity and Inclusion (DE&I) Committee and the AUA Public Policy Council overlap and have recently sparked impactful collaboration (Figures 1 and 2).

Figure 1. Dr Larissa Bresler, AUA Diversity, Equity and Inclusion (DE&I) Committee Chair and Chief Diversity Officer of the AUA North Central Section.
Figure 2. AUA Diversity, Equity, and Inclusion Committee.

One example is the AUA Annual Urology Advocacy Summit, which affords urologists a unique opportunity to visit Capitol Hill lawmakers and advocate for meaningful changes. Our advocacy efforts in support of the Veterans’ Prostate Cancer Treatment and Research Act illustrate merits of these efforts. This legislation supports a comprehensive standardized system of treatment for veterans as well as a real-time registry and research to track patients’ progress. Clinical pathways are critical for establishing better health outcomes for veterans and are based on multidisciplinary research. A prostate cancer clinical pathway would cover a patient’s prostate cancer journey from early detection to advanced disease and end-of-life care.4

The AUA has championed this legislation since 2019 and included it in the legislative priorities during the 2019 AUA Summit during our Capitol Hill meetings (Figure 3). The bill unanimously passed the House of Representatives on September 22, 2020. Because legislation often requires multiple sessions of Congress to become law, we continued our legislative advocacy in the following Congress. The bill was reintroduced in the House and Senate in 2021 and was eventually passed into law as part of the year-end Consolidated Appropriations Act in 2022.4 Implementation of this advocacy success story will begin this year.

Figure 3. Welcome back to Capitol Hill! Pictured left to right: Norm Smith, MD; Representative Rodney Davis (D-IL 07); Peter Bajic, MD; Larissa Bresler, MD.

The recent 2023 AUA Advocacy Summit also featured collaboration of the Public Policy Council and DE&I Committee. Denise Asafu-Adjei, MD, MPH, who is the AUA DE&I Committee Pipeline Workgroup leader and the 2023 AUA Gallagher Scholar, provided an overview of this year’s main legislative priorities and congressional “asks” during the first day of the Summit. Several advocacy initiatives facilitated reaching for health equity in prostate cancer care. A number of other DE&I Committee members, including the Chief Diversity Officer, also attended the Summit and contributed to the AUA advocacy efforts.

A focus of the 2023 Summit was the PSA Screening for Him Act. AUA joined with ZERO–The End of Prostate Cancer, along with more than 20 patient advocacy organizations and other stakeholders from across the prostate cancer community, to support this new bill co-sponsored by members in both the Senate and the House.5 In 2023, the incidence of prostate cancer was expected to increase for the first time in 20 years, likely because of changes to the screening guidelines over the last decade.6,7 African American men have a disproportionately higher rate of prostate cancer and are 70% more likely to be diagnosed with prostate cancer than White men. Moreover, African American men are 2.3 times more likely to die from prostate cancer, and are diagnosed with more aggressive disease and at younger ages compared to White men in settings of equal access to treatment. This racial disparity in mortality is currently the most pronounced among all cancers in the United States.8 Reducing health disparities in prostate cancer will require lowering barriers for screening to maximize the early detection of cancer when it is at its most treatable and least lethal stage. The bill waives deductibles, copayments, and coinsurance for prostate cancer screenings for those at highest risk of developing the disease, such as men with a family history of prostate cancer or those who are African American. This important bill aims to decrease the financial toxicity of screening and improves access to early detection.8

Achieving health equity in prostate cancer care requires concerted and collaborative efforts by patient advocacy groups, stakeholder organizations, and professional groups like the AUA, including the Public Policy Council and DE&I Committee.

  1. Washington C, Goldstein DA, Moore A, Gardner U, Deville C. Health disparities in prostate cancer and approaches to advance equitable care. Amer Soc Clin Oncol Educ Book. 2022;(42):360-365.
  2. Hinata N, Fujisawa M. Racial differences in prostate cancer characteristics and cancer-specific mortality: an overview. World J Mens Health. 2022;40(2):217-227.
  3. Lillard JW, Moses KA, Mahal BA, George DJ. Racial disparities in Black men with prostate cancer: a literature review. Cancer. 2022;128(21):3787-3795.
  4. American Urological Association. Policy and Advocacy Brief: House Passes Veteran’s Prostate Cancer Legislation. Urology Place. September 23, 2020. Accessed July 16, 2023.
  5. American Urological Association. Policy and Advocacy Brief: AUA Joins ZERO in Endorsement for The PSA for HIM Act (H.R. 1176). Urology Place. October 27, 2022. Accessed July 16, 2023.
  6. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA A Cancer J Clinicians. 2023;73(1):17-48.
  7. Murphy A, Bingham P, Burnett A. Breaking down barriers to PSA screenings. AUANews. 2023;28(6):42-43. Accessed July 16, 2023.
  8. American Urological Association. PSA for HIM Act Endorsement Letter. October 6, 2022. Accessed July 16, 2023.