The dire cancer incidence and mortality statistics for Black patients compared with White patients are well known. Collectively, Black individuals have the highest mortality rate and shortest survival of any racial or ethnic group in the United States for most cancers. Black men also have the highest cancer incidence rate,1 including higher rates of prostate cancer, and they are nearly 2.5 times more likely to die of the disease than non-Hispanic White men.2 The question is why these racial disparities persist.
“We know there is interplay among multiple factors contributing to both the unequal cancer burden and differences in outcomes between the races.”— Ashutosh K. Tewari, MD
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Research into health disparities has shown that the problem is complex and multifactorial, including socioeconomic status, access to health care, and behavioral factors, as well as comorbidities and their influences on pelvic inflammation, tumor microenvironment, and tumor biology, according to the results of a recent study by Ashutosh K. Tewari, MD, Chair of the Milton and Caroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai in New York City, and colleagues.
The study reviewed epidemiologic evidence in a variety of areas of racial disparity in prostate cancer in Black patients, including genomic and molecular differences in the oncogenesis and progression of prostate cancer; tumor microenvironment, protumor inflammation, escaping antitumor immune response, and tumor-induced angiogenesis; noncoding and micro-RNA disparities; and anatomic and molecular correlations between Black and White men with prostate cancer. It then offers guidelines for managing prostate cancer in Black patients based on their disease biology to improve outcomes.
“To determine the reasons for prostate cancer disparities between Black and White men, we have to think about cancer as a circle within a circle; in the center of the circle is a core reason, but we don’t know what that specific core reason is,” said Dr. Tewari. “We know there is interplay among multiple factors contributing to both the unequal cancer burden and differences in outcomes between the races, including management of comorbidities such as obesity, hypertension, and diabetes; access to health care; stage at diagnosis; and treatment effectiveness. I’m not saying that prostate cancer is more aggressive in Black men; I’m saying the cancer is different.”
Proactive Strategy to Improve Survivorship
in Black Men With Prostate Cancer
According to Dr. Tewari, managing those comorbidities will help reduce prostate cancer incidence and mortality in Black men, as will improve access to high-quality health care to screen and detect prostate cancer at an earlier, more curable stage. Genomic profiling to integrate clinical and genomic data for the diagnosis, prognosis, and treatment of Black patients with prostate cancer will allow a more precise approach to treatment, including novel immunotherapies, and contribute to better outcomes for these patients.
To proactively support these strategies to reduce prostate cancer incidence and mortality in Black men, this fall, Dr. Tewari and his colleagues at Mount Sinai Health System are launching the Robert F. Smith Mobile MRI Unit to bring prostate health care to Black communities in Harlem in New York City and its surrounding boroughs, including Queens and the Bronx. The mobile unit will provide prostate-specific antigen screening tests and schedule follow-up visits for patients with urologists from Mount Sinai Health System. The goal is to reach about 2,000 men within the first year of operation.
“If we can find prostate cancer early enough and provide effective treatment in a timely manner, we may be able to offset any of the disadvantages currently impacting worse outcomes in this patient population,” said Dr. Tewari.
DISCLOSURE: Dr. Tewari has held a leadership position with and equity in Promaxo; and has received grants from Blank Family Foundation, Intuitive Surgical, Department of Defense, AxoGen, Oncovir, Inc.-Poly ICLC, National Institutes of Health, National Cancer Institute, National Institute on Drug Abuse, Kite Pharma, Lumicell, and Dendreon.
1. American Cancer Society: Cancer Facts & Figures for African Americans 2019–2021. Available at www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2019-2021.pdf. Accessed May 27, 2021.
2. Dess RT, Hartman HE, Mahal BA, et al: Association of Black race with prostate cancerspecific and other-cause mortality. JAMA Oncol 5:975-983, 2019.