Genetics may not have much to do with why Black men are more likely to die of prostate cancer than white patients, a new study suggests.
For the study, published in the June 2023 issue of Lancet Digital Health, researchers examined tumor biopsy data for almost 13,000 men with advanced prostate cancer. Scientists also analyzed detailed clinical information including screening and treatment history for a subset of about 1,200 men in this group. About 12 percent of the men in the study were of African ancestry; most of the other men were of European ancestry.
More than one in five Black men had genetic mutations that could help guide their prostate cancer treatment, similar to the white patients in the study. But Black men often went through at least two different treatments before they received genetic testing that would tailor therapy to their specific tumor types, waiting longer than white men for targeted cancer drugs.
“This study suggests that genomics may not drive disparities in advanced prostate cancer,” says the senior study author, Brandon Mahal, MD, of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine in Florida.
“When men with similar disease characteristics are treated with similar treatments, they tend to have similar outcomes regardless of race,” Dr. Mahal says. “So, while this study suggests that genomics may not drive disparities in advanced prostate cancer, there is still a reason to study genomics as a risk of developing cancer — while addressing the barriers to care of systemic structural issues that can ultimately impact the risk of mortality.”
For Black Men, Prostate Cancer Is Often Diagnosed at More Advanced Stages
Black men are almost twice as likely to develop prostate cancer and more than twice as likely to die of these tumors as other U.S. men, Mahal says. This is likely due in part to environmental factors such as stress or systemic racism. But it’s also due to a lower rate of prostate cancer screening and less access to the most effective cancer treatments, Mahal adds.
The study found that Black men get screened when prostate cancer is more advanced, and that these men are far more likely to receive care at community hospitals that lack access to some of the most advanced therapies more typically offered at academic medical centers. Black men also had very limited access to clinical trials that might offer newer medicines in development, the study found.
One limitation of the study is that it focused on men with advanced tumors that are much harder to treat and have worse survival outcomes. It’s possible that results might be different for men with tumors caught earlier through screening.
Structural Racism Contributes to Worse Health Outcomes for the Black Community Across Multiple Conditions
Even so, the findings offer fresh evidence of the toll that structural racism takes on Black men’s health, says Daniel Spratt, MD, the chair and a professor of radiation oncology at Case Western Reserve University School of Medicine in Cleveland.
“People for centuries have associated countless observations to African-Americans and assumed they were driven by their genetic code, when in reality it appears that most of the differences observed in health outcomes are driven by structural racism and massive disparities in social determinants of health,” says Dr. Spratt, who wasn’t involved in the new study.
One thing Black men can do to overcome obstacles to care is get what’s known as a prostate specific antigen (PSA) test to screen for cancer, Spratt advises. Men ages 55 to 69 are advised to discuss PSA tests with their doctors, but these conversations are especially important for Black men.
“Most men won’t have prostate cancer, and of those that do, many may not even need treatment,” Spratt says. “However, early detection is key.”
