Examining the Racial Disparities in Prostate Cancer

Vince, Randy; Jamieson, Scott; Mahal, Brandon A.; Underwood, Willie

doi:10.1016/j.urology.2021.08.004

Cited by 25 publications

(20 citation statements)

References 43 publications

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“…Although the latest USPSTF guidelines recommended against screening in all younger men, PSA screening intensity and duration in younger Black men continues to be a subject of ongoing research and debate ( 12 ). Data from major clinical trials such as the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Study; the European Randomized Study of Screening for Prostate Cancer; the Göteborg prostate cancer screening trial; and the Cluster Randomized Trial of PSA Testing for Prostate Cancer generated controversial conclusions ( 13-17 ). These major clinical trials on prostate cancer screening also included limited numbers of Black participants, raising the concern that their findings may not be generalizable to Black men ( 13-17 ).…”

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confidence: 99%

“…Data from major clinical trials such as the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Study; the European Randomized Study of Screening for Prostate Cancer; the Göteborg prostate cancer screening trial; and the Cluster Randomized Trial of PSA Testing for Prostate Cancer generated controversial conclusions ( 13-17 ). These major clinical trials on prostate cancer screening also included limited numbers of Black participants, raising the concern that their findings may not be generalizable to Black men ( 13-17 ). Modeling studies informed by natural history, age, and racial or ethnic differences within national databases have suggested that targeted PSA screening strategies that apply an earlier screening age for Black men could provide survival benefits that outweigh harms of overtreatment ( 18 , 19 ).…”

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Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020

Qian

Khatib

Chen

et al. 2023

JNCI Cancer Spectrum

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Background United States Preventive Services Task Force (USPSTF) recommended against prostate specific antigen (PSA) screening in 2012, which was modified into shared decision making for men aged 55-70 with life expectancy over 10 years in 2018. We studied the trends in PSA screening in younger Black and White men with the implementation of 2012 and 2018 guidelines. Methods Younger Black and White men (aged 40-54 years) were identified using Behavioral Risk Factor Surveillance System database biennially from 2012 to 2020. Our primary outcome was PSA screening within two years of the survey. An adjusted logistic regression model with two-way interaction assessment between race and survey year was used to investigate the temporal trend of PSA screening in younger Black and White men. Results A total of 142,892 men were included. We saw steadily decreasing odds of PSA screening among both younger Black and White men in 2014, 2016, 2018, and 2020 compared to 2012 (for younger Black men: OR2014=0.77 [95%CI=0.62, 0.96], OR2016=0.51 [95%CI=0.41, 0.63], OR2018=0.33 [95%CI=0.27, 0.42], OR2020=0.25 [95%CI=0.18, 0.32]; and for younger White men: OR2014=0.81 [95%CI=0.76, 0.87], OR2016=0.66 [95%CI=0.61, 0.71], OR2018=0.41 [95%CI=0.37, 0.44], OR2020=0.36 [95%CI=0.33, 0.39]). Younger Black men showed brisker decrease in PSA screening in year 2016, 2018, and 2020 compared to younger White men (all p < 0.05). Conclusions PSA screening among younger men steadily decreased over the past decade since 2012 USPSTF guidelines, demonstrating a narrowing racial gap. How such observed trend translates to long-term clinical outcomes for younger Black men remains to be seen.

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confidence: 99%

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confidence: 99%

Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020

Qian

Khatib

Chen

et al. 2023

JNCI Cancer Spectrum

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“…38 In addition, black men with terminal metastatic cancer are more likely to experience aggressive medical interventions such as cardiopulmonary resuscitation and inpatient admission, which contribute to decreased quality of life, higher financial burden, and adverse psychological effects. 39 As a result, PCSM rates remain higher in black men, 40,41 particularly in patients with lowrisk PCa. [42][43][44] Ultimately, treatments for PCa varied amongst different races, including Hispanic, Asian, black, and white men.…”

Section: Prostate Cancer Treatmentmentioning

confidence: 99%

Racial Disparities and Mental Health Effects Within Prostate Cancer

Conant

Huynh

Chan

et al. 2022

Health Psychology Research

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Disparities in prostate cancer (PCa) exist at all stages: screening, diagnosis, treatment, outcomes, and mortality. Although there are a multitude of complex biological (e.g., genetics, age at diagnosis, PSA levels, Gleason score) and nonbiological (e.g., socioeconomic status, education level, health literacy) factors that contribute to PCa disparities, nonbiological factors may play a more significant role. One understudied aspect influencing PCa patients is mental health related to the quality of life. Overall, PCa patients report poorer mental health than non-PCa patients and have a higher incidence of depression and anxiety. Racial disparities in mental health, specifically in PCa patients, and how poor mental health impacts overall PCa outcomes require further study.

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“…2 Concentrated poverty in African American communities (ie, income-and race-based segregation) is one form of structural racism. 2,3 It may influence the risk of prostate cancer 4 and disease prognosis 3 by direct or indirect effects of social determinants of health, limiting access to medical care, 5,6 including timely diagnosis, treatment, or by influencing biological processes (ie, increasing allostatic load, 7 chronic stress signaling, 8,9 immune function, 10 and inflammation 11 ), or increasing exposure to adverse environments, with reduced opportunities to engage in healthful behaviors. [12][13][14] Yet, few studies have investigated the association between neighborhood deprivation and prostate cancer 2,4,15,16 or examined its association with levels of circulating immune-oncology markers.…”

Section: Introductionmentioning

confidence: 99%

Association of Neighborhood Deprivation With Prostate Cancer and Immune Markers in African American and European American Men

et al. 2023

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ImportanceNeighborhood variables may be factors in the excessive burden of prostate cancer among African American men.ObjectiveTo examine associations between neighborhood deprivation, circulating immune-oncology markers, and prostate cancer among African American and European American men.Design, Setting, and ParticipantsA case-control study was conducted between January 1, 2005, and January 1, 2016. Participants included men with prostate cancer and age- and race-frequency-matched population controls. Participants were recruited at the Baltimore Veterans Affairs Medical Center and University of Maryland Medical Center; controls were obtained through the Maryland Motor Vehicle Administration database. National Death Index follow-up was performed through December 31, 2020, and data analysis was conducted from February 1, 2022, through October 31, 2022.Exposures2000 Census-tract Neighborhood Deprivation Index as a standardized score.Main Outcomes and MeasuresPrimary outcomes included prostate cancer, all-cause mortality, and disease-specific mortality. Secondary outcomes included the National Comprehensive Cancer Network risk score and serum proteomes for 82 immune-oncology markers with pathway annotation.ResultsParticipants included men with prostate cancer (n = 769: 405 African American, 364 European American men) and age- and race-frequency-matched population controls (n = 1023: 479 African American, 544 European American men). The median survival follow-up was 9.70 years (IQR, 5.77 years), with 219 deaths. Among 884 African American men, mean (SD) age at recruitment was 63.8 (7.6) years; mean (SD) age at recruitment among 908 European American men was 66.4 (8.1) years. In the multivariable logistic regression analysis with individual socioeconomic status adjustment, neighborhood deprivation was associated with 55% increased odds of prostate cancer among African American men (odds ratio [OR], 1.55; 95% CI, 1.33-1.81), but was not associated with the disease among European American men. Residing in the most-deprived vs least-deprived neighborhoods corresponded to 88% higher disease odds (OR, 1.88; 95% CI, 1.30-2.75) among all men and an approximate 3-fold increase among African American men (OR, 3.58; 95% CI, 1.72-7.45), but no association was noted among European American men. In Cox proportional hazard regression analyses, socioeconomic status–adjusted neighborhood deprivation was associated with an increased all-cause mortality only among African American men (hazard ratio [HR], 1.28; 95% CI, 1.08-1.53), whereas it was associated with metastatic disease and a 50% increased hazard of a prostate cancer–specific death among all men (HR, 1.50; 95% CI, 1.07-2.09). In analyses restricted to controls, neighborhood deprivation was associated with increased activity scores of serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression.Conclusions and RelevanceThe findings of this study suggest that deprived neighborhood residency may increase the risk of African American men for prostate cancer and a related mortality, potentially through its association with systemic immune function and inflammation.

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Examining the Racial Disparities in Prostate Cancer

Cited by 25 publications

References 43 publications

Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020

Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020

Racial Disparities and Mental Health Effects Within Prostate Cancer

Association of Neighborhood Deprivation With Prostate Cancer and Immune Markers in African American and European American Men

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