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According to the American Cancer Society, approximately 1 in 9 men will develop prostate cancer at some point during their lifetime. Nearly 100% of men who are diagnosed with early-stage, localized prostate cancer will survive the disease, but this figure drops dramatically to only a 32% five-year survival among men who are diagnosed with advanced-stage prostate cancer.1 As a result, early diagnosis is critical for reducing mortality from the disease. 

Racial disparities in health care limit early diagnosis among certain vulnerable minority groups. Research indicates that Black men, who are at higher risk for prostate cancer overall, also are twice as likely to receive a higher grade diagnosis.2 White men, on the other hand, are more likely to receive a prostate cancer diagnosis before the disease reaches an advanced stage, improving their therapeutic outcomes and increasing their likelihood of survival.3 Given higher rates of low-risk disease among white men, this population also is eligible to receive more localized, less aggressive treatments; findings confirm that white men are significantly more likely to undergo radical prostatectomy than Black men, who typically must undergo radiation, especially for metastatic prostate cancer.4

Researchers are working to systematically identify demographic factors that may underlie these racial disparities in cancer stage at diagnosis. For example, given that Black men are usually younger than white men at the time of diagnosis, physicians suspect that prostate cancer may develop more quickly and aggressively in Black men than in white men. Additionally, prostate cancer has been linked to certain genetic mutations in Black men but not white men, suggesting that certain genetic factors contribute to increased risk.4 

However, biological factors are thought to account for less than 40% of the race-based differences in prostate cancer stage at diagnosis.2 In fact, modifiable factors (such as socioeconomic status and health care access) are primarily responsible for inequities in diagnosis. People of higher socioeconomic status, who are significantly more likely to be white than Black,5 face fewer resource-related barriers to regular cancer screenings6 and as a result are more likely to discover prostate cancer at an earlier stage. Additionally, access to primary care is limited among people of lower socioeconomic status, who are less likely to have high-quality health insurance7 and may face discrimination when seeking primary care.8

Researchers confirmed the socioeconomic basis of disparities in prostate cancer diagnosis by studying neighborhood deprivation, a measure of socioeconomic and health conditions based on factors such as high poverty rate, low level of educational attainment, limited access to transportation, and other demographic factors. The study found that the most deprived neighborhoods also have the highest rates of severe prostate cancer at time of diagnosis for both Black men and white men.9 These findings suggest that racial disparities in diagnosis are mediated by socioeconomic conditions and that socioeconomic status is better than race as a better predictor of late-stage prostate cancer diagnosis. 

Health disparities research strongly indicates that equitable access to health care would begin to close the diagnostic gap between Black men and white men. Critically, efforts to minimize these racial disparities early in the prostate cancer management process will reduce the disproportionate burden of cancer morbidity and mortality among Black men. 

References

1 Howard J, Hankey BF, Greenberg RS, et al. (1992). A collaborative study of differences in the survival of rates of black patients and white patients with cancer. Cancer, 68(9):2349-2360. 

2 Jones BA, Liu WL, Araujo AB, et al. (2008). Explaining the race difference in prostate cancer stage at diagnosis. Cancer Epidemiology, Biomarkers, and Prevention, 17(10):2825-2843.

3 Zhang C, Zhang C, & Wang Q. (2020). Differences in stage of cancer at diagnosis, treatment, and survival by race and ethnicity among leading cancer types. JAMA Network Open, 3(4):e202950.

4 Jiang S, Narayan V, & Warlick C. (2018). Racial disparities and considerations for active surveillance of prostate cancer. Translational Andrology and Urology, 7(2):214-220. 

5 Noël RA. (2018). Race, economics, and social status. U.S. Bureau of Labor Statistics. Accessed from: https://www.bls.gov/spotlight/2018/race-economics-and-social-status/pdf/race-economics-and-social-status.pdf

6 Pruitt SL, Shim M, Mullen PD, et al. (2010). The association of area socioeconomic status and breast, cervical, and colorectal screening: A systematic review. Cancer Epidemiology, Biomarkers, and Prevention, 18(10):2579-2599. 

7 McMaughan DJ, Oloruntoba O, & Smith ML. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health. 

8 Olah ME, Gaisano G, & Hwang SW. (2013). The effect of socioeconomic status on access to primary care: An audit study. Canadian Medical Association Journal, 185(6):e263-269.

9 Zeigler-Johnson CM, Tierney A, Rebbeck TR, & Rundle A. (2011). Prostate cancer severity associations with neighborhood deprivation. Prostate Cancer.