Originally published 5/10/2015
More than 6 years have passed since we posted the blog below, and we’re not happy to report that in spite of some small gains, inequalities in prostate cancer statistics remain. A 2021 publication out of the American Society of Clinical Oncology (ASCO) offers an updated analysis of disparities among screening, detection, diagnosis and treatment among PCa patients. The paper by Cackowski, et al. opens, “Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent.”[i] Factors include ethnicity, race, socioeconomics, education level, geographic locations (urban vs. rural), and patient perceptions/trust. A persistent statistical trend shows that Black men with localized PCa are less likely than White men to receive definitive treatment (surgery or radiation). The same pattern is observed regarding use of molecular imaging (PET/CT scans). Another factor that differentiates PCa treatment is socioeconomic status. Men with low status are less likely to receive definitive treatment. On the other hand, when treatment is equally distributed, Black men and White men appear to benefit equally, with similar response to treatment. In fact, in some treatments for metastatic PCa, including immunotherapies, Black men tend to have longer survival rates, though whether this may be due to genomic differences is unclear. The authors recommend the following measures:
a) More studies of novel therapies stratified by race
b) Use of patient navigation with clinical therapies and trial enrollment in underserved patient settings
c) Enhanced and guideline-driven use of genomic testing to personalize therapies, and
d) Standardization of treatment such that care is delivered in more equal access environments and pathways for optimal outcomes
All of us at Sperling Prostate Center embrace the value of equal access to care in order to end inequities in PCa treatment and results.
In an ideal prostate cancer world, men would have equal access to education about their prostate health, screening opportunities, diagnostic procedures and treatment choices. If this were so, we would expect that rates of treatment success, side effects from treatment, and prostate cancer-specific mortality would then be evenly distributed across all patients.
A newly published review of the literature reveals that this is not the case. The research was done through the Cancer Council Queensland (Queensland, Australia), Australia’s leading non-government organization in cancer control. Their literature review is in keeping with their mission which reads in part, “Our goal is cancer control through all actions that aim to reduce the burden of cancer on all individuals and the community in support of our vision for a cancer free future.” Although this aim is lofty, the kind of research they conduct is in the service of their purpose to provide universally even cancer care.
What they accomplished was a four month-long survey of all published literature from published from January 1998 to January 2014.[ii] They identified 91 papers that contained relevant global data on the following topics:
- PSA testing
- Incidence of prostate cancer
- Risk of advanced stage prostate cancer
- Access or use of definitive treatment
- Survival and mortality rates
You will not be surprised to learn that there are significant differences between urban and rural areas, and between affluent and disadvantages population groups. The predominant patterns are probably exactly what you would expect. Internationally, urban areas show more men being screened, higher incidence of localized PCa (likely the result of more active screening) and fewer diagnoses of advanced PCa, greater access to or use of definitive treatments, and greater survival rates. This aligns with the findings for economic groups: affluent areas around the globe likewise reflect more screening and higher incidence rates of localized PCa, less risk of advanced disease, more use of definitive treatments, and higher survival rates.
In short, men who live in rural and/or disadvantaged areas are less likely to be screened, more likely to be diagnosed with advanced PCa, less likely to have access to effective treatments for either localized or advanced disease, and therefore more likely to die from PCa. This is an unconscionable—but sadly real—situation. I’m grateful to Cancer Council Queensland for making us aware of the inequities in prostate cancer services and outcomes, and even more for their efforts to bring our planet closer to an ideal world.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Cackowski FC, Mahal B, Heath EI, Carthon B. Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal? Am Soc Clin Oncol Educ Book. 2021 Mar;41:1-12.
[ii] Baade PD, Yu XQ, Smith DP et al. Geographic disparities in prostate cancer outcomes – review of international patterns. Asian Pac J Cancer Prev. 2015;16(3):1259-75.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
