African-American and Hispanic men in the U.S. are less likely to receive therapy for prostate cancer compared to Caucasian men—even when they have more aggressive disease, according to new research from Roswell Park Cancer Institute, Buffalo, N.Y., and Vanderbilt University Medical Center, Nashville, Tenn. The study, senior authored by Willie Underwood, III, MD, MPH, MSci, has been published online ahead of print in Urology (2016; DOI:10.1016/j.urology.2016.07.045).
“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,” said Underwood, Associate Professor in the Department of Urology at Roswell Park. “This research demonstrates a need for an action plan to address a racial disparity that has been known for more than 20 years.”
The study was based on data for 327,641 men diagnosed with localized prostate cancer between 2004 and 2011, as reported to the national Surveillance, Epidemiology, and End Results Program. The researchers evaluated factors including race, age, treatment, Gleason score, marital status, year of diagnosis, D'Amico risk classification, and whether or not the men received definitive treatment.
The researchers concluded that African-American men and Hispanic men were less likely to receive therapy compared to Caucasian and Asian-American men, even when they had high risk prostate cancers (Gleason score of 7 or higher). It is possible that many of these men had opted to defer treatment while continuing in the care of medical professionals, an approach known as watchful waiting or active surveillance.
They also analyzed the data using the D'Amico risk model, which calculates the risk of recurrence following localized treatment for prostate cancer. The analysis reveals that African-American men diagnosed within each category—low-, intermediate-, and high-risk disease—had significantly lower odds of receiving definitive treatment. Hispanic men with intermediate- or high-risk disease also had lower odds of receiving treatment.
In what is believed to be the largest analysis of prostate cancer treatment patterns among Asian-American men, the researchers report that men of Asian descent were older and had more advanced disease at the time of diagnosis, and Asian-American men were as likely to receive treatment as Caucasian men. Results for Asian-Americans and Caucasians were similar in the Gleason score and D'Amico analyses.
“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,” noted Kelvin Moses, MD, PhD, lead author and 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.”