Decision regret worse among African American men with prostate cancer

January 19, 2021
Jason M. Broderick

Higher medical mistrust and concerns about masculinity likely contribute to the increased decision regret.

Compared with non-African American men (nAAM), African American men (AAM) are significantly more likely to suffer from decisional regret related to their prostate cancer treatment, according to a survey-based study published in the Journal of Urology.1

Using statistical modeling to assess survey data, the investigators determined that AAM were nearly 2.5 times more likely than nAAM to experience decisional regret (odds ratio [OR], 2.46; P <.0001).

Based on patient responses from their novel survey, the Prostate Cancer Beliefs Questionnaire (PCBQ; 1 of 4 surveys the study used), the researchers concluded that higher distrust of the healthcare system and worries about masculinity likely contribute this disparity in decisional regret.

"African American men suffer worse decisional regret than non-African American men, which may be partially explained by higher medical mistrust and concerns about masculinity as captured by the Prostate Cancer Beliefs Questionnaire. This novel survey may facilitate identifying targets to reduce racial disparities in prostate cancer,” the authors wrote.

Surveys were sent out and received by 1048 patients with local prostate cancer who had undergone treatment at the Cleveland Clinic during the period from 2010 to 2016. The cohort was matched by several factors including race, medical status at baseline, and treatment.

Patients were sent 4 surveys: the Expanded Prostate Cancer Index Composite (EPIC) 26, the Decisional Regret Scale, the investigators’ novel PCBQ, and a modified EPIC demographics form.

According to the investigators, their PCBQ evaluates beliefs about prostate cancer risk factors, medical mistrust, and concerns about masculinity.

Overall, 378 (36.07%) surveys were completed. Of the completed surveys, 146 (38.73%) were from AAM and 231 (61.27%) were from nAAM.

Baseline demographics by race showed comparable data between the 2 groups in terms of age at treatment, Gleason Score, time since treatment, and rates/types of primary and secondary treatments. However, pretreatment PSA level was slightly higher in the AAM population. There was also variance between the groups in terms of relationship status, annual income, and education level.

Baseline demographics for AAM included a mean age of 62.27 years, a mean of 6.07 years since treatment, and a mean pretreatment PSA of 9.13 ng/ml. Sixty percent of patients had a Gleason score of ≥7. Primary treatment included active surveillance (4.8%), brachytherapy (41%), cryotherapy (4%), prostatectomy (51%). Six patients received secondary treatment, which included brachytherapy (1), cryotherapy (1), external beam radiation therapy (EBRT; 2), and prostatectomy (2).

Also among the AAM group, 80% of responders reported being in a significant relationship, 8% of patients had a reported annual income of more than $100K, and 13% were college graduates.

Demographics at baseline for the nAAM group included a mean age of 63.09 years, a mean of 5.84 years since treatment, and a mean pretreatment PSA of 6.39 ng/ml. Sixty-five percent of patients had a Gleason score of ≥7. Primary treatment included active surveillance (4.7%), brachytherapy (43%), cryotherapy (3%), prostatectomy (50%). Eleven patients received secondary treatment, which included brachytherapy (2), EBRT (5), and prostatectomy (4).

Also in the nAAM group, 88% of responders reported being in a significant relationship, 32% of patients had a reported annual income of more than $100K, and 25% were college graduates.

The analysis showed that AAM had higher scores on the PCBQ for both medical mistrust and masculinity issues. Further, both medical mistrust (OR, 1.415) and masculinity (OR, 1.350 scores) were predictive of worse decisional regret independent of race.

In their study conclusion, the authors wrote, “This information may help inform counseling of patients, and has the potential to reduce racial disparities in patients’ experience with prostate cancer by targeting opportunities for education and improved communication.”

Reference

1. DeWitt-Foy ME, Gam K, Modlin C, et al. Race, decisional regret and prostate cancer beliefs: identifying targets to reduce racial disparities in prostate cancer. J Urol. 2021;205(2):426-433. doi: 10.1097/JU.0000000000001385