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Prostate cancer is the most common cancer among American men. The American Cancer Society estimates that in 2020, nearly 200,000 men will be diagnosed with prostate cancer and more than 33,000 will die from the disease in the United States alone. A disproportionate number of these deaths will occur among men from racial/ethnic minority groups, particularly among Black men, who are two to three times more likely than white men to die from prostate cancer. Despite these well-documented outcomes, scientific understanding of these alarming health inequities remains limited. Researchers have responded with renewed efforts to tease apart the complex interactions of health determinants—including genetics, socioeconomic status, and health care access—that may underlie these disparities in prostate cancer outcomes.  

 

This growing body of research has determined that inequities exist at all stages of the cancer care process, from screening to diagnosis to treatment. Studies indicate that disparities in diagnostic management may be partly responsible for the disproportionate burden of prostate cancer among men from racial/ethnic minority groups. Black men and Hispanic men in particular tend to face a number of barriers to accessing the best diagnostic imaging procedures. 

 

First, according to recent census data, Black men and Hispanic men are disproportionately more likely than white men to be uninsured or to rely on public health insurance,  significantly limiting their ability to pay for cost-intensive imaging techniques. Second, geographic analyses reveal that Black and Hispanic men also are more likely to live in low-income areas and experience increased travel times to academic medical centers that offer high-quality imaging review. Additionally, research finds that most physicians hold implicit negative attitudes towards people of color and that these biases can influence their treatment decision-making processes.  All factors considered, Black and Hispanic patients are significantly less likely than white patients to receive gold-standard diagnostic management for prostate cancer, regardless of insurance status. 

 

Researchers have confirmed that these social, economic, and geographic disparities do, in fact, limit access to imaging procedures that meet accepted diagnostic management guidelines. Data from recent studies indicate that: 

 

  • Black men were nearly four times less likely than white men to receive a new, highly promising method called Ga-PMSA-11 PET-CT. Black men were more likely to receive the standard, less effective method, called F-flucicovine PET-CT.
  • Black men and Hispanic men were less likely than white men to receive prostate multiparametric MRI, which is increasingly indicated as a highly effective diagnostic imaging method.
  • Among men who were suspected to have prostate cancer, Black men were less likely than white men to receive MRI-ultrasound fusion biopsy (FBx), a superior modality for detecting early prostate cancer compared to other diagnostic tests.

 

Across the broad array of diagnostic imaging techniques, Black men and Hispanic men are significantly less likely to receive the most effective, cutting-edge procedures for detecting and diagnosing prostate cancer. Poor diagnostic management and limited access to high-quality care are early-stage failures in the long chain of health disparities that culminate in high prostate cancer mortality among men of color. Providers and health systems must strive to ensure that all patients receive equitable access to the highest-quality available screening and diagnostic procedures. 

 

Author: Natasha Crumby

1 American Cancer Society. Cancer Facts & Figures 2020. Atlanta: American Cancer Society. (2020). Accessed from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf

 

2 Chornokur G, Dalton K, Broysova M, & Kumar N. (2011). Disparities at presentation, diagnosis, treatment, and survival in African American men affected by prostate cancer. Prostate, 71(9):985-997.

 

3 United States Census Bureau. Report P60-264: Health Insurance Coverage in the United States: 2017. Accessed from https://www.census.gov/library/publications/2018/demo/p60-264.html

 

4 Gilbert SM, Pow-Sang JM, & Xiao H. (2016). Geographical factors associated with health disparities in prostate cancer. Cancer Control, 23(4):401-408. 

 

5 Hall WJ, Chapman MV, Lee KM, et al. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health, 105(12):e60-76. 

 

6 Bucknor MD, Lichtensztajn DY, Lin TK, et al. (2020). Disparities in PET imaging for prostate cancer at a tertiary academic medical center. Journal of Nuclear Medicine

 

Calais J, Ceci F, Eiber M, et al. (2019). 18F-fluciclovine PET-CT and 68Ga-PSMA-11 PET CT in patients with early biochemical recurrence after prostatectomy: A prospective, single-centre, single-arm, comparative imaging trial. The Lancet Oncology, 20(9):1286-1294. 

 

8 Washington C & Deville C. (2020). Health disparities and inequities in the utilization of diagnostic imaging for prostate cancer. Abdominal Radiology

 

9 Hoge C, Verma S, Lama DJ, et al. (2020). Racial disparity in the utilization of multiparametric MRI-ultrasound fusion biopsy for the detection of prostate cancer. Prostate Cancer and Prostatic Diseases.