No Race Disparities in Prostate Cancer Outcomes Within VA Healthcare System

No Race Disparities in Prostate Cancer Outcomes Within VA Healthcare System

shutterstock_190865222In a recent study titled “VA Study Reveals No Race Disparities in Prostate Cancer Outcomes, published in Prostate Cancer and Prostatic Diseases, researchers found that among prostate cancer patients who receive medical care in the Veterans Affairs (VA) healthcare system, there are no significant differences in tumor burden, treatment choice, and survival outcomes between black and white men.

“The observed lack of disparity in outcomes between African Americans and Caucasians may be due to their receipt of care in the equal-access VA healthcare system, which may eliminate or reduce major barriers in access to care for African Americans,” the authors write in their study.

In earlier studies, a 48% higher incidence of prostate cancer along with an increased risk of death was found among black men. Furthermore, at the time of diagnosis, black men had higher prostate specific antigen (PSA) levels and bigger tumors, with an increased tendency to present an advanced form of this disease.

In this study, the research team led by Timothy J. Daskivich, MD, of the University of California, sampled a total of 1,258 men diagnosed with non-metastatic prostate cancer between 1998 and 2004. They then compared tumor characteristics, treatment choice, cancer-specific and other-cause mortalities between African Americans and Caucasians.

Overall, the team found no significant differences in any of the measured outcomes, even though there was no control for socioeconomic status and education (which could reduce discrepancies).

According to the authors, one of the possible explanations for these results “is that the adverse effects of low socioeconomic status, poor insurance, low education and lack of usual source of care that traditionally are associated with African-American race are diminished in the VA setting. This may lead to improved rates of screening, earlier detection of disease, more equitable provision of costly treatments and the resultant improvement in long-term outcomes.”

Another explanation could be that Caucasian men tend to have worse disease features in the VA system compared to other settings, this way reducing the apparent discrepancy.

Importantly, the authors note that their study had some limitations, including selection bias related to the study design. “Veterans with worse disease at diagnosis may not seek care at the VA, which would falsely reduce racial disparity in all of our main outcomes beyond tumor burden at diagnosis”, researchers wrote.