A disturbing new study published in JAMA Network Open suggests that there are major racial gaps influencing the treatment of prostate cancer. The study found that, when compared to their white counterparts, black men still remain less likely to get aggressive therapy for prostate high-risk cancer. Such a treatment gap may be associated with poor survival outcomes in this cohort.
In this blog from the Best cancer hospital in India, we will discuss the implications of the major findings of this study and the results they have. Finally, we will discuss the larger matter of racial prejudices in prostate cancer treatment and what changes should be made to allow for equal treatment for all patients.
Understanding the Study on Treatment Disparities
This was exhausted in 2020 in a think-about of treatment designs over 37,000+ men analyzed with prostate cancer between 2015 and 2019. They come about the thought based on data collected from three US cancer teachers.
The goal was to compare how frequently active surveillance vs. definitive treatment (surgery or radiation) gets used for low-risk vs. high-risk prostate cancer in Black men compared to white men.
Key Findings:
For low-risk prostate cancer, rates of active surveillance were comparable between Black and white men. This suggests equitable use of conservative management when appropriate.
On the other hand, in cases of high-risk prostate cancer, 32% and 43% of black men and white men, respectively, received definitive treatment with the same prognostic outcomes.
However, despite the higher-risk disease status that black men presented with, it was active surveillance that they were chosen more frequently.
Adjusting for age, comorbidities, and Gleason grade decreased black men’s odds by 29% of receiving surgery or radiation for high-risk prostate cancer.
Treatment patterns did not improve from 2010-2015. Racial differences persisted across all years studied.
This study controlled for clinical factors and still detected racial treatment biases. The authors conclude that lingering misconceptions about prostate cancer in Black men, along with financial barriers, continue influencing management options offered by doctors.
Why This Matters for Survival
Overtreatment of insignificant prostate cancers causes needless side effects, so active surveillance provides benefits when appropriate. However, active surveillance for high-risk diseases can seriously impact outcomes.
High-risk prostate cancers are more likely to metastasize and require timely, intensive therapy. Treatments like radical prostatectomy and radiation therapy remain the standard of care to prevent mortality.
However, this study indicates doctors disproportionately manage high-risk prostate cancer in Black men with monitoring instead of these guideline-recommended treatments. As a result, survival disparities widen.
Black men already face more than double the prostate cancer mortality rate compared to white men. Inadequate treatment of aggressive prostate cancer exacerbates this survival gap.
Closing racial biases in the management of high-risk prostate cancer represents a tangible way to improve outcomes for Black patients. Increased use of definitive therapy aligns with goals to enhance prostate cancer survival, quality of life, and health equity overall.
Factors Underlying Treatment Disparities
The data from the Best ayurvedic cancer hospital in India say various complex factors underpin the treatment differences highlighted in this study:
Implicit racial biases of providers shape treatment choices presented to patients.
Doctors may preferentially recommend aggressive therapy less often to Black men.
Unequal access to high-quality cancer care prevents some Black men from seeing specialists who follow current guidelines closely.
Medical mistrust due to past mistreatment may make some Black men reluctant to accept doctor recommendations.
Financial difficulties can limit eligibility for costly new radiation techniques with fewer side effects.
Assumptions about Black men tolerating pain and side effects better may affect treatment selections.
Beliefs that prostate cancer behaves less aggressively in Black men still pervade.
Lack of diversity among cancer researchers may contribute to treatment gaps going unrecognized.
Without confronting these realities, inequities in prostate cancer care cannot improve.
Steps to Take Toward Health Equity
Achieving truly equitable prostate cancer treatment requires work across individual, community, and system levels:
For patients:
Seek multiple opinions if given treatment options that seem misaligned with disease status.
Voice concerns and preferences openly with your care team. Ask direct questions.
Connect with prostate cancer support groups, especially those focused on issues for Black men.
Advocate for equitable screening and treatment access within marginalized communities.
For providers:
Examine your own biases. Provide the same recommendations you would give another patient with an identical prognosis, regardless of race.
All appropriate treatment options are aligned with guidelines and the patient’s risk level.
Probe patient hesitance and address concerns transparently. Clarify misconceptions respectfully.
Ensure high-risk patients see specialists, including radiologists, to discuss radiation.
For policymakers and advocates:
Spread awareness around treatment disparities and the dangers of misconceptions that cancer in Black men differs.
Make research funding available to study health inequities and pilot interventions.
Increase Medicaid coverage for prostate cancer care.
Invest in patient navigator programs to guide underserved individuals through treatment.
Conclusion
With a multifaceted approach - from bedside manner to system reforms - we can ensure prostate cancer treatment aligns with clinical needs, not demographics. While challenges remain, a future of equitable cancer care is possible through sustained effort.
