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Sustained commitment needed to brighten prostate cancer picture for Black men | Viewpoint

Opinion
Article

Early detection is key to saving lives and narrowing the prostate cancer health disparity gap.

Prostate cancer is a devastating disease, established as the second most common type of cancer and the second leading cause of cancer deaths among men in the United States. One in eight men will be diagnosed with the disease, and one in 41 will die from it.

Submitted images

Walter Rayford, left, and Spencer Heaton

Racial differences in prevalence, outcome, and mortality rates in prostate cancer can be seen between Black and white men. The disease afflicts one in six Black men, compared with one in eight white men. Black men are also more likely to be diagnosed at a younger age, with more aggressive disease, and are more than twice as likely to die from the disease. To eliminate these disparities and ensure equitable care, we must first explore the challenge and systemic issues behind the racial divide.

Our country’s legacy of social inequities and systemic racism — including less access to quality education and safe housing, employer bias in hiring practices, and other challenges – also extends to the realm of healthcare. Black people often experience a lack of access to high-quality care (either because of income disparities, geographical location, or both), and they suffer from disproportionately high rates of chronic disease, poorer outcomes, and higher mortality rates across the board as a result.

There is also evidence that certain biological and genetic factors, and even the characteristics of cancerous prostate tissues that differ among racial groups, may play a role in the difference in outcomes between the races.

While we cannot solve systemic social inequities overnight, we know that early detection is key to saving lives and narrowing the prostate cancer health disparity gap.

Early screening can help close the gap

A study published last year in the New England Journal of Medicine Evidence analyzed three decades of Prostate-Specific Antigen (PSA) results to determine how often they led to overdiagnosis and overtreatment. The study revealed that among Black men, a prostate cancer screening test prevented one death for every eight to 12 men diagnosed, and one death for every five to nine men treated. What’s more, the five-year relative survival rate for Black men diagnosed with prostate cancer at any stage is 97% and increases to 99% when the disease is caught early, according to Zero, a nonprofit focused on ending the disease.

The American Cancer Society recommends that men at high risk, including Black men and those who have a brother or father who have had prostate cancer, get screened starting at age 45, and the American Urological Association recommends screenings start at age 40. Yet only one-third of eligible Black men participate in prostate cancer screenings.

Community collaboration is key

Clinicians can help by discussing the racial disparities seen in prostate cancer outcomes with their Black patients and family members and promoting the benefits of early screening and testing.

Additionally, many community-based organizations, such as churches and community centers, are raising awareness of the issue and providing access to preventive screenings. And programs from pharma companies, like Johnson & Johnson’s Our Race to Health Equity initiative, are encouraging Black men to talk with their doctors.

But much more work is needed to fully understand why prostate cancer is more common among Black men than any other racial or ethnic group.

To that end, clinicians have been calling for the inclusion of more underrepresented minorities in prostate cancer research. They’ve also gained a deeper understanding of the benefits of genomic analysis.

Over the last decade, genomic profiling of prostate tumors has provided insights that improve the understanding and treatment of the disease. Precision medicine has emerged to guide therapeutic approaches for patients with prostate cancer by offering us deeper knowledge of each altered gene or pathway in an individual, leading to the improvement of clinical outcomes.

Additionally, the Consortium on Disparities of Urologic Conditions (ConDUC), a nonprofit organization that promotes the highest standards of urological clinical care through education, research, and the formulation of healthcare policy, is developing a global registry.

The goal of the registry is to enroll Black men with all stages of prostate cancer to help physicians, life sciences companies, and other stakeholders better understand the natural history, treatment regimens, and outcomes of the disease, and to help enroll more Black men into clinical trials for prostate cancer therapies. High-quality, prospective data on long-term outcomes have been lacking in prostate cancer for Black men, who make up only a small percentage of patients in most current and previous registries.

Health equity has become a hot topic in healthcare, and we applaud the attention to the issue. But words without actions are meaningless. To truly make a difference and reduce or eliminate racial disparities in prostate cancer – and in all diseases – we need a sustained commitment from all stakeholders.

About the authors

Walter Rayford is president of the Consortium on Disparities of Urologic Conditions (ConDUC). He is an associate professor in the Department of Preventive Medicine at the University of Tennessee.

Spencer Heaton is chief medical and commercial officer of LynxDx, Inc. He’s a physician executive with decades of experience in healthcare delivery, healthcare technology services, and medical research.

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