“In general, African-American men have more aggressive disease. So here’s a treatment which is actually no treatment: active surveillance. Data suggests African-American men are likely to progress on active surveillance, but that doesn’t mean it shouldn’t be offered. It just means they should be followed closely—not that it’s not worth trying.
We’re also seeing that when African-American men are matched stage-for-stage, grade-for-grade, they do similarly after surgery and with radiation as white men. When you get to late-stage chemo, there is data they’re actually doing better. That’s great, but it opens up a million questions as to why.
From a clinical perspective, we must consider their Gleason, their PSA, and their genomics and come up with a treatment plan. Race shouldn’t really figure into it.
Socioeconomics may contribute to people waiting too long to come in, but even in equal-access centers, black men are diagnosed at younger ages than white men. It’s not simply waiting too long. Socioeconomics clearly is a factor. Being poor is clearly a stress factor, particularly in the United States, and we know stress can increase cancer risk and aggressiveness. So a lot of factors are in play.
I’m hopeful these studies will lead to more men getting screened earlier. They’re more likely to have aggressive disease, but if it’s caught early the outcomes are identical to what we see in white men. That’s the silver lining about this.”
Stephen Freedland, MD / Los Angeles
Next: “The studies are a bit controversial, and other big-data studies of large databases across Medicare and the country clearly show that African-American men are still more severely affected by prostate cancer."