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The recruitment of Black men for clinical trials has been a factor overlooked by many studies. In the U.S., prostate cancer incidence and mortality vary by race. Prostate cancer incidence and mortality are higher in Black men than their non-Black counterparts.

There have been multiple phase 3 clinical trials over the past 5 years that have established that the drugs docetaxel, abiraterone acetate, apalutamide, or enzalutamide, coupled with androgen deprivation therapy (ADT), can significantly improve survival rates for men with metastatic hormone-sensitive prostate cancer (mHSPC).

A randomized (1:1) trial compared enzalutamide in addition to ADT or bicalutamide with ADT in 71 men with mHSPC. The significance of this study is that it was a prospective randomized clinical trial of men with mHSPC who were treated with a novel hormonal therapy where subset analysis of outcomes in Black men was prespecified, thus addressing the underrepresentation of Black men in prostate cancer clinical trials.

There is growing evidence that socioeconomic barriers related to care contribute to the poor prognosis and outcomes of Black patients, thus leading to higher mortality rates. Contrary to evidence indicating worse outcomes at the population level, recent findings suggest that Black men with metastatic prostate cancer may respond better to systemic therapy than non-Black men.

Black men with metastatic prostate cancer treated with either docetaxel, abiraterone acetate, or enzalutamide have been shown to have outcomes similar to, if not better than, non-Black men. These findings beg the question why Black men have higher mortality rates while exhibiting similar outcomes to systemic therapy for metastatic disease? Future studies should evaluate how this discrepancy is associated with inequitable care caused by socioeconomic barriers [1].

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[1] Hahn, A. W., Bilen, M. A., & Agarwal, N. (2021). Successful Recruitment of Black Men to Prostate Cancer Clinical Trials—A Lesson in Achievement. JAMA Network Open, 4(1), e2034652. https://doi.org/10.1001/jamanetworkopen.2020.34652