African-American and Hispanic prostate cancer patients are at higher risk of aggressive disease — but less likely to be treated for their cancer — than whites or people of Asian descent in the United States, researchers reported.
The study, “Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter,” published in the journal Urology, was developed at the Roswell Park Cancer Institute and Vanderbilt University Medical Center.
“Despite their higher risk for more aggressive disease, African-American men and Hispanic men are less likely to receive treatment, and less treatment may play a significant role in increased rates of death from prostate cancer,” Dr. Willie Underwood, the study’s senior author and an associate professor in the Department of Urology at Roswell Park, said in a news release. “This research demonstrates a need for an action plan to address a racial disparity that has been known for more than 20 years.”
Despite a reduction in prostate cancer mortality over the last three decades, studies have found continuing racial differences in mortality rates. For example, African-American patients have a 2.4-fold risk of death compared to whites. Black men are more often diagnosed at a younger ages and with more aggressive disease, factors that likely contribute to this disparity. But a fuller explanation was also thought to rest in treatment differences.
To examine racial and ethnic differences in treatment by cancer aggressiveness, Underwood and colleagues analyzed data from 327,641 men, diagnosed with prostate cancer from 2004 to 2011, who were part of the national Surveillance, Epidemiology and End Results (SEER) Registry. Factors included in the analysis were race, age, marital status, Gleason score (which classifies tumor aggressiveness), treatment, year of prostate cancer diagnosis, risk classification, and whether or not the patient had received definitive treatment.
African-Americans and Hispanics were less likely to receive treatment, including those with high-risk prostate cancers (as assessed by a Gleason score of 7 or higher), compared to white and Asian-American men, the researchers found. However, they noted that many of these men may have opted to postpone treatment while continuing with active surveillance.
African-American men were also significantly less likely to receive definitive treatment within each risk classification (low, intermediate, or high-risk of cancer recurrence after localized prostate cancer treatment) compared to Caucasians. Hispanic men with intermediate- or high-risk disease were also less likely to receive treatment. (Definitive treatment was defined as radical prostatectomy plus radiotherapy, or a combination of post-surgery therapies.)
Although the results showed that Asian-American men were older and had their prostate cancer in a more advanced state at the time of diagnosis, these patients were as likely to be treated as Caucasians. Asian-Americans and whites had similar Gleason score and risk classification results.
“This data shows a significant disparity in the rates of prostate cancer treatment among African-American men and an emerging disparity among Hispanic men, compared to the broader population,” said Kelvin Moses, MD, PhD, the study’s lead author and an assistant professor of Urologic Surgery at Vanderbilt University Medical Center. “We hope that these findings will inspire physicians and public health organizations to develop interventions to help address these persistent disparities.”