Study shows racial disparities in choice of prostate cancer treatment

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 the results published in Cancer.1

Results showed that across the VHA, race did not appear to influence receipt of definitive treatment; however, black men with prostate cancer have been reported to receive less definitive treatment in high-benefit situations than non-black patients.

Study results 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 benefit from definitive treatment were 40% more likely to receive treatment than those who did not need it (P <.001 despite the benefits of advanced care currently available for this patient population black males who were highly likely to benefit from treatment less receive than non-black patients an age and severity similar diseases ratio>P <.001>

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

Previous findings have indicated that black patients are less likely to undergo definitive treatments for prostate cancer than men of other races. However, whether this is due to avoiding overtreatment in people with low-risk disease and avoiding life-changing side effects such as erectile dysfunction and incontinence remains to be determined. 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 the benefits of prostate cancer treatment.

The 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 of those included in the study had over 60, were married and had no significant comorbidities.

The men were characterized according to life expectancy and disease severity. For example, while a man in his 50s with aggressive disease who has undergone surgery or radiation therapy would be considered a high-benefit patient, older men with non-aggressive prostate cancer would be categorized as low profit.

Other study results indicated that black patients are more often diagnosed with prostate cancer 2 years earlier than patients from other racial groups of all ages. However, this population is more likely to be diagnosed with more aggressive disease. Further research needs to be conducted to identify the forces that are responsible for these racial disparities.

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

The references

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

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

Martin E. Berry