Advanced prostate cancer treatments are more likely to be available to Black men than to those of other races. They are 11 percent less likely to receive them than to non-Black men. A new study of American veterans has shown that this is despite the fact that there are no equal opportunities to access health care services.The study was published in Cancer Online June 29. It showed that Black men were slightly more likely (5%) to have radiation or surgery for prostate carcinoma than those of other races. Additionally, veterans of all races were 40 percent more likely that they would receive it than those who didn't need it.Researchers from NYU Langone Health, Perlmutter Cancer Center led the analysis. It showed that, despite the many advantages of advanced care, Black men who have aggressive prostate cancer were 11 percent less likely than non-Black men to receive them. Other research shows that Black patients are three times more likely than non-Black patients to succumb to the disease."Our study suggests that Black men may not be receiving the best prostate cancer treatments (which are often more in-depth) or that they are being offered these 'high-benefit' treatments less aggressively than non-Black patients," said Joseph Ravenell, MD, study co-investigator and associate dean for diversity affairs at NYU Langone.Ravenell, an associate professor at NYU Grossman school of Medicine and coleader of community engagement and outreach at Perlmutter Cancer Center says that there may be a reason for the treatment gap. Previous studies have shown that Black patients have greater concerns about side effects such as incontinence or erectile dysfunction. He suggests that Black patients should discuss these fears and other concerns about their expectations regarding treatment when considering treatment options.Danil Makarov MD, MHS, senior investigator of the study, urologic surgeon, said, "Our findings strongly suggest that patients and doctors should discuss fears and values when considering all possible treatment options for prostate cancer.""Despite the many advances in prostate cancer treatment over the last few decades, there are still racial disparities and there is much to be done to understand why these are happening and what we can finally do to close the gap," Makarov, an associate Professor in the Departments for Urology and Population Health at NYU Grossman school of Medicine.Makarov, who is also a Perlmutter Cancer Center member, said that "at the end of the day, our goal is offer patients the best cancer care possible using a culturally sensitive approach". His team is currently studying interventions such as counseling Black men about their risk and the benefits of screening for prostate cancer. This could help reduce disparities in care.These findings are based on an analysis of medical records from 35,427 men who were treated for prostate cancer from 2011 to 2017. The majority of these men were older than 60 years old, had never been married and had no other serious health issues.This study confirmed previous research that Black men are more likely to develop prostate cancer 2 years earlier than other races. Black men are more likely to develop more severe forms of the disease that their non-Black counterparts. Makarov believes that more research is necessary to establish if there is an underlying cultural or structural bias behind this disparity.Researchers used data from both Medicare and the Veterans Health Administration Corporate Data Warehouse to conduct the study. They used these national databases to identify all men with prostate cancer. Then they compared their life expectancy and severity. For example, men in their 50s who were diagnosed with aggressive prostate cancer and had undergone surgery or radiation treatment were considered to have received high-benefit treatment as it had the highest impact on their lives. Because these treatments had no impact on their life expectancy, older men with less aggressive cancers would be considered "low" for aggressive prostate cancer treatment.VHA data was chosen by researchers because it is the largest provider of cancer treatment in the country.American men still die from prostate cancer every year, which is the second leading cause of death from cancer. According to the U.S. National Cancer Institute, prostate cancer will affect 248,000 men by 2021. This is most likely in its early stages.###U.S. Department of Veterans Affairs grant VAI15-356, Prostate Cancer Foundation, John and Daria Barry Precision Oncology Center of Excellence of VA New York Harbor Healthcare System and The Edward Blank and Sharon Cosloy-Blank Family Foundation provided funding support.Other NYU investigators are Shannon Ciprut and Makarov. Dawn Walter, BS, Dawn Walter, MPH, Chan Wang, PhD, Aisha Langford and Herbert Lepor, MD. Daniel Becker, MD. Huilin Li, Ph.D., and Stacy Loeb MD, MSc. Temitope Rude at Upland Hills Health, Madison, Wis., Angela Fagerlin at the University of Utah, Salt Lake City, and John Leppert at Stanford University, Palo Alto (Calif.) are other study investigators.Media inquiries:David MarchCall 212-404-3512david.march@nyulangone.org
