Editor's Note: For this month’s installment of “Speak Out,” urologists were asked to discuss recent studies indicating African-American men with prostate cancer may be put on active surveillance without suffering complications and that they respond to radiation and some chemotherapy better than Caucasian men. The research discussed includes the scientific meeting presentations “Overall survival by race in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate or enzalutamide” (presented at the 2019 GU Cancers Symposium), “Androgen receptor activity and radiotherapeutic sensitivity in African-American men with prostate cancer: A large scale gene expression analysis and meta-analysis of RTOG trials” (2018 ASTRO annual meeting), “Prostate cancer upgrading and upstaging in a multicenter prostate cancer registry” (2018 AUA annual meeting), and a paper published in the Journal of Clinical Oncology (2019; 37:403-10).
“If you start from the premise that African-American men have more aggressive prostate cancer, you can break the reasons down into socioeconomics and biology. These studies basically account for socioeconomic status and for staging. If everybody is on the same playing field, according to one study, radiation is a viable option for African-American men, for at least one particular gene expression. Radiation can give them a better response than Caucasian men.
In the real world, however, the playing field is not even, because black men aren’t getting screened. They show up with metastatic disease. If you can get them screened, this study shows they can do just as well, if not better than whites.
It’s the same with active surveillance. If someone is in an active surveillance protocol, they’ve already been screened and qualified for active surveillance. So they’ll do just as well.
People took it for granted that the black men did worse with prostate cancer with no dissection of why. Some of it was just believing that there had to be something different genetically. Maybe that still is likely, but this study dispels the idea that it’s just biology that causes African-American men to have worse cancer.”
Michael Bivins, MD / Birmingham, AL