By Lisa Rapaport
(Reuters Health) - Black men with riskier prostate cancers may be less likely than their white counterparts to get aggressive treatment that can give them the best survival odds, a recent U.S. study suggests.
Researchers focused on men with medium- and high-risk localized prostate tumors likely to benefit from aggressive treatment like surgery or radiation, rather than the conservative approaches of watchful waiting or hormone therapy often used for men with low-risk tumors.
While 83% of white men received aggressive treatment, just 74% of black men did, the study found.
“Given the evidence suggesting a benefit for treatment in men diagnosed with intermediate- and high-risk prostate cancer, our findings may explain, to some degree, the differences in survival odds between black and white men diagnosed with prostate cancer," said lead study author Dr. Quoc-Dien Trinh, co-director of the Dana-Farber/Brigham and Women's Prostate Cancer Center in Boston.
Black men are more likely to develop prostate cancer and to die from it than white men, the researchers note in European Urology, online August 2. Black patients are also more likely to be diagnosed when tumors are more advanced and more difficult to treat.
For the current study, researchers examined national cancer registry data on 223,873 white men and 59,262 black men aged 40 or older diagnosed with prostate tumors in the U.S. between 2004 and 2013.
Half of the white men in the study were at least 65 years old, while half of the black men were at least 63.
Black men were more likely to be low-income and uninsured or covered by Medicaid, the U.S. health program for the poor.
During the study period, the proportion of white men receiving aggressive treatment rose from 81% to 83%, while for black men it increased from 73% to 75%.
Overall, 39% of the 356 facilities in the study were significantly more likely to give aggressive therapy to white men than to black men with similar tumors. Only 1% of facilities were more likely to give aggressive treatment to black men.
Geography also played a role. For example, in the southeastern U.S., white men were 69% more likely to receive aggressive treatment than black men, the study found.
“From a system-level perspective, we need to do a better job to (standardize) prostate cancer counseling and recommendations,” Trinh said by email. “There is no reason why there would be such a variation in how black men are treated from one institution to another.”
One limitation of the study is that researchers lacked data on patient preferences that may have driven treatment decisions. Researchers also lacked data on patients treated at smaller facilities and places that treated fewer than 50 men a year for prostate cancer.
It’s also hard to say how many patients may have opted against aggressive treatment because they didn’t trust their physician or worried about side effects like urinary incontinence or erectile dysfunction, said Dr. Simpa Salami, a urologist at the University of Michigan in Ann Arbor who wasn’t involved in the study.
“We do not know if black men were offered definitive therapy at the same rate as white men but chose other options instead, or if black men were simply not offered the same treatment options as white men,” Salami said by email.
Differences in income and insurance may also help explain the disparities in how men were treated, said Dr. Brian Chapin of the University of Texas MD Anderson Cancer Center in Houston.
“I would expect that if a comparison was made between whites and blacks within the same income bracket and equivalent insurances, the findings may not have been as significantly different,” Chapin, who wasn’t involved in the study, said by email.
Even so, the findings suggest that men should speak to more than one doctor before deciding how to proceed, Chapin said.
“I would encourage any newly diagnosed prostate cancer patient to obtain a second opinion regarding their cancer care, and meet with both a radiation oncologist and a urologist to be presented with all available options and make sure they are fully informed before making a treatment decision,” Chapin advised.
Eur Urol 2017.