Study shows racial disparities in prostate cancer treatment selection

A study of patients treated through the Veteran’s Health Administration (VHA) found that Black men with prostate cancer were less likely to choose or be offered the most beneficial treatment options, according to results published in Cancer.1

The findings showed that within the VHA overall, race does not appear to influence the receipt of definitive treatment; however, Black men with prostate cancer were reported as receiving less definitive treatment in high-benefit situations than non-Black patients.

Findings from the study indicated that Black veterans with prostate cancer were 5% more likely to receive radiation therapy or surgery than non-Black patients (P <.001).2 Additionally, veterans of all races who were likely to derive benefit from definitive therapy were 40% more likely to receive treatment than those who did not require it (P <.001). Despite the advantages of advanced care that are currently available to this population of patients, Black men who were highly likely to derive benefit from treatment were 11% less likely to undergo treatment than non-Black patients of a similar age and disease severity (odds ratio, 0.89; P <.001).

“Our study suggests, for reasons that remain unclear, that Black men who need treatment may be choosing against the most beneficial prostate cancer therapies (which are often more invasive), or that such 'high-benefit' treatments, are not being offered to them as aggressively as they are to non-Black patients,” co-investigator Joseph Ravenell, MD, associate dean for diversity affairs and inclusion at New York University (NYU) Langone, associate professor at NYU Grossman School of Medicine, and co-leader of community outreach and engagement at the Perlmutter Cancer Center, stated in a press release.

Previous findings have indicated that Black patients trend toward undergoing definitive prostate cancer treatments less than men of other races. However, it has yet to be seen as to whether this is due to avoidance of overtreatment in those with low-risk disease and avoid life-changing adverse effects such as erectile dysfunction and incontinence. Another reason for these disparities could be a reduction in appropriate care. This inspired the study’s investigators to examine the role of race in prostate cancer treatment benefit.

Investigators behind the retrospective cohort study identified 35,427 men through the VHA Corporate Warehouse who had been diagnosed with low- to intermediate-risk disease from 2011 to 2017. The majority who were included in the study were over the age of 60, were married, and had no notable comorbidities.

Men were characterized based on life expectancy and disease severity. For example, while a man in his 50s with aggressive disease who had undergone surgery or radiotherapy would be considered a high-benefit patient, older men with non-aggressive prostate cancer would be categorized as low benefit.

Additional findings from the study indicated that Black patients are more commonly diagnosed with prostate cancer 2 years earlier than patients of other racial groups of all ages. However, this population is more likely to be diagnosed with more aggressive disease. Additional research must be conducted to identify the forces that are responsible these racial disparities.

“Despite great strides in prostate cancer care over the past few decades, racial disparities in care persist, and there remains a lot to be done to better understand why this is happening and what we can do to finally close the gap. At the end of day, our goal is to offer patients the most appropriate cancer care they need, using a culturally sensitive approach,” Danil Makarov, MD, MHS, an associate professor in the Departments of Urology and Population Health at NYU Grossman School of Medicine, concluded.

References

1. Study sheds light on persistent racial disparities in prostate cancer care in the United States. News Release. NYU Langone Health. June 29, 2021. https://bit.ly/2VAt4V7

2. Rude T, Walter D, Ciprut S, et a. Interaction between race and prostate cancer treatment benefit in the Veterans Health Administration. Cancer. Published online June 29, 2021. doi: 10.1002/cncr.33643