Black men are less likely to treat prostate cancer properly
Prostate cancer is not an equal opportunity disease. Black men in the United States have significantly higher mortality rates from prostate cancer than the general population. They are also more likely to be diagnosed with an aggressive form of the disease, which is usually treated with surgery and radiotherapy. However, black men are less likely to seek treatment than white patients, and when they do, their doctors are more likely to recommend a watch-and-wait approach rather than surgery or radiotherapy, according to the latest research.
Variation in accidents and treatments
A study, published in July in the European Urology Medical Journal, examined data from the National Cancer Registry of nearly 224,000 white men and just over 59,000 black men aged 40 and over who were diagnosed with prostate cancer between 2004 and 2013. The researchers found that 83 percent of white men were treated with surgery or radiation compared to 74 percent of black men. Overall, more than a third of the 356 facilities included in the study were more likely to treat white men with surgery, radiotherapy, or treatment with the same strength, than black men with similar tumors. In just 1 percent of facilities, the numbers skewed in favor of black men receiving surgery and radiotherapy more often than white patients.
Cancer experts don’t know the reasons behind this disparity, but they say that educating black patients about their options is critical to their prognosis. “The misconception that all prostate cancers are slow and that you ‘will die with it and not because of it’ must be dispelled,” says Dr. Scott Shilvo, MD, medical director of urology at our hospital near Atlanta. “African Americans have different screening recommendations and should have different screening recommendations when screening begins at age 40, rather than 55 for a white man with no family history of the disease.”
Compared to white men, African American men are two times more likely to develop prostate cancer and two times more likely to die from it.
Treatment approaches vary depending on the type and stage of prostate cancer and the level of risk that the cancer has spread. Options vary widely, from active surveillance, which includes active monitoring of the early stages of the disease for signs of growth, to hormone therapy, surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of treatments.
Risks, Treatments, and Costs
Previous studies have identified race as a distinguishing factor in who receives prostate cancer treatment. A 2013 study published in the Journal of Clinical Oncology found that non-white men were less likely to undergo surgery for prostate cancer. It also concluded that a higher proportion of black patients with stage II, III, or IV disease receive no treatment compared to whites.
The reasons may have something to do with the way men view the disease. A recent study, presented in June at the annual meeting of the American Society of Clinical Oncology, suggests that black and white men prioritize treating prostate cancer differently. Researchers at the University of North Carolina Leinberger Comprehensive Cancer Center surveyed nearly 900 white men and nearly 300 black men about two key questions: How aggressive is your cancer, and what is important to you in dealing with it?
81% of black men in the medium or high-risk cancer category considered recovery time to be very important, compared to 50% of white men. Two-thirds of black men said the cost was very significant: more than twice that of white men. Nearly three-quarters of black men with intermediate or high-risk cancer rated the effect of treatment on their daily activities as very important, while 58 percent of white men gave it the same rating.
When talking to each patient, the researchers knew how aggressive their cancer was based on medical records that included biopsy information and a prostate-specific antigen (PSA) test. More than half of black patients mistakenly believe their cancer was not very aggressive, compared to 24 percent of white men. The study authors concluded that a poor understanding of their cancer’s aggressiveness may be a factor in the treatment options men chose and their eventual outcome.
Overcome fear and mistrust
“I don’t think anyone knows for sure why there is a disparity between aggressive treatments for Caucasian and African American men, and it’s likely not just one cause, but several,” Dr. A 2004 study “Culture, Black Men, and Prostate Cancer: What’s the Reality?” Published in the Journal of the Moffitt Cancer Center , it was suggested that one reason may be that black men in general are less likely to participate in prostate cancer screening due to their mistrust, fear, and disconnection from the health care system.
“It could also be a lack of access to care or access to ongoing follow-up, a lack of education about the variation between prostate cancer types, because there is a lot of misinformation about prostate cancer, about detection and treatment.” Dr.. Shelfo says. This misinformation, and its potential impact on the way black men are treated for cancer, is particularly concerning given how dangerous prostate cancer is. “While many of the prostate cancers we found are slow-growing, a significant portion are not, and are aggressive, high-grade cancers that can shorten or eliminate a man’s life,” he says, adding that studies show how important they are for men, especially blacks. Guys, to talk to your doctor about when to start prostate cancer screening.
Read more about prostate cancer treatment options.