What Patients Can Do as Racial Disparities Persist in Prostate Cancer

As racial disparities persist regarding prostate cancer, relationships between patients and providers, as well as patient education and self-care, can be crucial factors in improving outcomes, experts said.

Black men are 60% more likely than White men to receive a diagnosis of prostate cancer in their lifetime, and more than twice as likely to die from prostate cancer than White men, noted Dr. Daniel J. George, Eleanor Easley Distinguished Professor in the School of Medicine at Duke University.

“There's a biological reason that this disease is happening more frequently and progressing more aggressively, and then there's also a social access construct that's affecting how they're cared for that also influences their outcomes,” said George.

George was the co-author of a literature review published in 2022 in the journal Cancer which analyzed data regarding racial disparities in prostate cancer.

“Racial disparities observed among Black men with [prostate cancer] are multifaceted, evolving from institutional racism,” George and his colleagues wrote. “Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on [prostate cancer] and treatment options, fear of [prostate cancer] diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time and cancer debt, play an important role in racial disparities observed in [prostate cancer] treatment and outcomes.”

Acknowledging that “there is a historical perspective to just be sensitive to for Black men and women in this country that have historically been underserved by our systems for decades,” George stressed the importance of patient/provider relationships — something which his research noted “must be improved.”

“Trust is something that we're all very familiar with in life, and it comes with experience … but with medicine, sometimes we don't have that luxury,” said George. “Patients present with disease that needs to be treated — sometimes with pretty radical treatment — right from the start. For people to put their faith into the person or the system that is going to perform that radical therapy, there needs to be trust. So, building that is so critical, and recognizing that there is a divide by our cultural races that we have to be at least cognizant of and intentional in addressing, the sensitivity around [that], is really important.”

What’s in Patients’ Control

Despite persistent obstacles and disparities, George noted that there is still “a lot that’s in our control,” starting with lifestyle choices for patients.

“Prostate cancer is a chronic disease, so recognizing the other health strategies that will absolutely affect your treatment outcome, both in terms of your tolerance of treatment, your response to treatment, and your long-term recovery from treatment. It's really important for you to understand what you can modify, to maximize your outcome, to get the best result you can have,” George said. “Those are things like your exercise, your diet, your sleep. We tend to ignore that, but they’re really important aspects.”

“Having regimens associated with your lifestyle … is so important because the treatments we give will modify your motivation. It'll be harder to diet and exercise and sleep. Because the treatments are going to interfere with those things, having a structure and regimen that make them consistent will help you push against those changes that therapy is likely to cause. … It's not simply prescribing a drug or doing a surgery or radiation, it's helping patients manage themselves and in own their health care as much as we do with them.”

Patients, George said, can also empower themselves with knowledge of their disease.

“The power to understand what is happening to your body gives you the ability to manage that and manage that psychologically, but also physically,” he said. “So, understanding your particular cancer … because it's different from the people you may know who have had prostate cancer, every case is not identical, and so recognizing and understanding where you fall in that continuum is really important.”

“Education is key for patients,” said Dr. Hiba Khan, a medical oncologist and assistant professor in the clinical research division of the Fred Hutchinson Cancer Center in Seattle. “There are lots of resources out there for patients to educate themselves about not only their risk for prostate cancer but once they are diagnosed with prostate cancer, different treatment modalities that are available, different tests that they could get that could further inform risk and treatment options.”

Resources, Khan said, are available via organizations such as the American Cancer Society and ZERO Prostate Cancer. Patients, once educated, should feel comfortable and open to speaking with their providers about what they’re learning and continue to advocate for themselves.

In turn, Khan said that patients can then engage in advocacy at a community level.

“Patients should feel free to talk with their family and their friends about their diagnosis of prostate cancer,” she said. “Sometimes I know that that's a difficult conversation to have, but raising awareness in Black communities and other underrepresented communities can only raise awareness, and that maybe ensures that other people will think about prostate cancer screening earlier or think about potentially talking with their providers about that.”

Additionally, it was noted that patients can also explore the possibility of helping to make enrollment in clinical trials more equitable.

“Racial diversity is often lacking in genomic and precision medicine studies,” George and his fellow researchers wrote. “Black men are largely underrepresented in key phase 3 [prostate cancer] trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams and bias of health care providers to recommend clinical research.”
“Equitable representation in clinical trials is a huge area where we, as a prostate cancer research community need to improve and we need to partner with patients in order to improve representation,” said Khan.

Patients, Khan advised, should ask their providers if there is a clinical trial they may be eligible for if they are interested.

“I think this is key — getting equitable, diverse enrollment in clinical trials because it informs the next treatment guidelines. We get more information about treatments that perhaps work differently in different populations, we're less able to generalize our clinical trial findings if we don't have a diverse enrollment of populations, so improving this is really key to overall improving outcomes.”

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