A new analysis uncovers a racial paradox in prostate cancer care: While Black men are often diagnosed later and with more aggressive disease than white men, radiation therapy seems to work better for them than for their white peers.
To come to that conclusion, researchers reviewed seven trials comprising more than 8,800 men with prostate cancer. Of these, 1,630 men were Black. Black men were younger than white men (68 versus 71, respectively) and had more advanced disease when they enrolled in these trials. All men received either standard or high-dose radiation therapy, and some also underwent hormonal treatments for the disease.
When compared with white men, Black men were 12% less likely to experience a recurrence of prostate cancer and 28% less likely to have their cancer spread to other organs or to die from prostate cancer after slightly more than 10 years of follow-up.
Calling the findings "unexpected," study author Dr. Amar Kishan said that access to care may play a role in the historically poor prostate cancer outcomes seen among Black men.
"When Black men with prostate cancer get the same standard of care treatment and are followed the same way as white patients, the survival differences at the very least go away and may even flip," said Kishan, who is vice chair of Clinical and Translational Research in the Department of Radiation Oncology and chief of Genitourinary Oncology Service at the University of California, Los Angeles.
It's also possible there is something about prostate cancer in some Black men that makes the cancer cells more sensitive to the effects of radiation therapy, Kishan noted. "The results would be at least the same if the major problem was barrier to care, but we don't have an explanation for the fact that outcomes were better yet," he noted.
Importantly, some of the trials included in the new review dated back to the 1980s. "These trials did not necessarily use cutting-edge radiation technology, which means that results may be even better with newer technology," Kishan said.
The study was published Dec. 29 in the journal JAMA Network Open.
"These data tell us if Black men have access to equitable care, we wouldn't see inferior outcomes as we see today in Black men with prostate cancer compared to white men," said Dr. Neeraj Agarwal, senior director for Clinical Research Innovation at the Huntsman Cancer Institute at the University of Utah in Salt Lake City.
"The biggest question is how to make sure Black men have access to equitable access to health care," said Agarwal, who co-wrote an editorial accompanying the new study.
"Black men with prostate cancer get less than optimal therapy," said Dr. Otis Brawley, a professor of oncology at the Johns Hopkins University School of Medicine in Baltimore.
It's not about the color of skin or race, said Brawley, who has no ties to the new study. "Black people are not biologically different than white people," he said. "Race is a socioeconomic category."
Many Black men live in poorer neighborhoods and have less access to high-quality care, Brawley explained.
Another cancer expert not involved with the study said more research is needed to interpret the findings.
"We have seen that the effect of race/ethnicity on treatment outcome can largely be abrogated if patients are diagnosed early and treated appropriately," said Dr. Madhur Garg, clinical director of radiation oncology at Montefiore Health System in New York City. "Clinical trial enrollment should be encouraged, to learn more about the biology of prostate cancer and whether certain treatments will be more effective than others based on race and ethnicity."
The American Cancer Society provides more information on diagnosing and treating prostate cancer.
SOURCES: Amar Kishan, MD, associate professor and vice chair, Clinical and Translational Research, Department of Radiation Oncology, chief, Genitourinary Oncology Service, University of California, Los Angeles; Neeraj Agarwal, MD, senior director, Clinical Research Innovation, Huntsman Cancer Institute, University of Utah, Salt Lake City;. Otis Brawley, MD, professor, oncology, Johns Hopkins University School of Medicine, Baltimore; Madhur Garg, MD, clinical director, radiation oncology, Montefiore Health System, New York City; JAMA Network Open, Dec. 29, 2021