Management of prostate cancer varies by race

A study published in The Journal of Urology® indicates that treatment for low-risk prostate cancer, rather than watchful waiting, is most likely to be sought by black men.

Prostate cancer diagnosis

The prostate gland is part of the male reproductive system. It is a walnut-sized gland, situated beneath the bladder and in front of the rectum, that produces some of the components of semen.

Cancer of the prostate gland is common, with over a million diagnoses being made each year. The incidence of prostate cancer is highest among African-American men and deaths from prostate cancer are almost 2.5 times more common in this group of men compared with the general population.

Although prostate cancer can grow and spread rapidly, it is relatively slow-growing in the majority of cases. For this reason, it is routine practice for men diagnosed with early prostate cancer not to receive treatment immediately.

Instead they are regularly monitored — watchful waiting —for signs or symptoms of aggressive cancer growth. However, some men elect to have treatment to eradicate the tumour or have the prostate surgically removed despite having a low-risk, slow-growing prostate cancer.

Researchers have analysed the management of over 2000 patients diagnosed with low risk prostate cancer at Kaiser Permanente Northern California between 2004 and 2012. Since this is an ethnically and economically diverse population, comparisons across a range of sociodemographic groups could be made.

Because Kaiser Permanente Northern California is a large, integrated health system covering a diverse population, it was possible to independently assess ethnic and economic influences on treatment choice."

Stephen Van Den Eeden, co-principal investigator for the study.

The results showed that race/ethnicity does influence the decision to undergo treatment despite watchful waiting being clinically indicated. Among the study population, non-Hispanic black men were more likely than white men to elect to have active treatment independent of clinical measures.

Interestingly though, among those who remained under surveillance, fewer non-Hispanic black men underwent repeat biopsy within 24 months of diagnosis compared with non-Hispanic white men.

These results are important as clinicians may be increasingly hesitant to require men to undergo serial re-biopsies due to complications, yet black men are known to have a greater likelihood of prostate cancer progression, which suggests that clinicians should be particularly vigilant in the surveillance of black men on active surveillance."

Scott P Kelly, Co-principal investigator.

Although there were differences between ethnic groups in the rate of uptake of active treatment among men on active surveillance, the main trigger for beginning active treatment was a change in clinical findings indicating an increased risk of disease progression, such as Gleason score and prostate specific antigen testing.

Nonetheless, the findings relating to ethnicity highlight the importance of ensuring that the tools used in the management of prostate cancer are racially and culturally tailored to individual patients. We need to ensure that treatment is not influenced by race, ethnicity, or socioeconomic status.

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