Study Finds Racial Disparities in Treatment of Clinically Significant Prostate Cancer


Key Points

  • Underuse of treatment occurred in 4% of patients with clinically significant prostate cancer.
  • Black men accounted for 92% of cases of underuse of treatment, with the majority of cases being due to system failures.

In a study reported in the Journal of Oncology Practice, Bickell et al found underuse of treatment for clinically significant prostate cancer was infrequent among white and black patients at two New York City hospitals, but black men accounted for nearly all such underuse of treatment. As noted by the investigators, black men are more likely to die as a result of prostate cancer than white men, despite the availability of effective treatments that have improved survival in clinically significant disease.

Study Details

The study was conducted at an academic hospital and a municipal hospital serving the Harlem community in New York City. All black men and a random cohort of age-matched white men with Gleason scores ≥ 7 diagnosed between 2006 and 2013 were identified to determine the rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. Treating physicians were interviewed regarding the reasons for underuse of treatment.

Underuse of Treatment

Overall, 575 men included in the study were treated at the academic center and 66 men were treated at the municipal hospital. Of the total of 359 black men and 282 white men, 25 (4%) experienced treatment underuse, with 23 (92%) being black; the rate of underuse was 6% among black men vs 1% among white men (P < .001). Underuse of treatment occurred in 16 men at the municipal hospital and 9 at the academic center. Overall, 77% of cases of underuse were due to system failures, in which treatment was recommended but not received, with black men accounting for all such cases; 38% of these men continued receiving care at their hospital. The remainder of underuse cases were due to patient refusal of recommended treatment or financial barriers.

The investigators concluded: “Treatment rates of prostate cancer are high. Yet, racial disparities in rates and causes of underuse remain. Only black men experienced system failures, a type of underuse amenable to health information technology–based solutions. Institutions are missing opportunities to use their health information technology capabilities to reduce disparities in cancer care.”

The study was supported by grants from the Department of Defense and the National Cancer Institute.

Nina A. Bickell, MD, MPH, of Icahn School of Medicine at Mount Sinai, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.