The staggering disparity in diagnoses and mortality rates of prostate cancer between Black and white men is a large enough concern for July’s Black Health Matters virtual summit to have devoted two sessions with prominent urology experts to it.
Dr. George Johnson, a partner at New Jersey Urology, and Dr. Lewis Kampel, medical director of Memorial Sloan Kettering’s Ralph Lauren Center for Cancer Care, were equally adamant about clinical trials holding potential answers and solutions. As with most illnesses and conditions, clinical trials for prostate treatment are practically devoid of Black patients, they said, and dramatically increasing the number of participants should reduce, or even eliminate, the disparity.
“Whether it’s that they’re not being asked—that’s probably the reason why we don’t see good representation,” Dr. Johnson, one of just a handful of African American board-certified urologists practicing in New Jersey, told his summit session. “And I encourage our audience to speak to their health care provider to ask about clinical trials.’’
Information about where and when prostate cancer clinical trials are taking place is readily available, he added: “Ask about them, research them, find out if you’re comfortable and if they’re safe. Absolutely be involved.’’
Dr. Kampel pointed to a well-known trial from the early 2000s on the drugs finasteride and Dutasteride that produced very mixed results on the prevention of prostate cancer. The problem, he said, was that Black men were very poorly represented in the trials.
“Maybe even though it didn’t work when you lumped a whole bunch of people together with only a small number of African American men, maybe if we looked at just the African American men, if there were enough of them in the trial, we would find that it was beneficial,’’ Dr. Kampel said.
“And, I might add, that the reverse could also be true. We might find a drug that works in the general population, but might not be tolerated well among the African American men, or women. So, it’s very important for clinical trials to include a broad spectrum of our population, so we can pick these things up.’’
Black men continue to be 1.7 times more likely to be diagnosed with prostate cancer than white men, and are 2.2 times more likely to die from it. It is the most frequently occurring cancer in men overall, and the second-most fatal.
“Why?’’ Dr. Johnson said of the imbalance. “Talk about disparities in income, in education, insurance status, and we can talk about cultural factors.’’
“There may be some fear of testing which may delay testing and diagnosis and results in a worse outcome,’’ Dr. Kampel said. He said access to treatment and care “clearly plays a role,’’ pointing to research done at VA hospitals: “When access is equal, these disparities narrow.’’
Numerous research organizations, including the American Cancer Society and the American Urological Association, have recently developed differing recommendations on prostate screenings, Dr. Johnson noted. The recommendations are based on heredity, risk levels and other factors, and affect the age at which screenings should begin and how often they should be given.
Starting regular screening at 50 is more often recommended now, Dr. Johnson and Dr. Kampel agree, as opposed to previous recommendations to begin at 40. And no matter a man’s age, open communication with his health care provider can be more beneficial than an annual exam.
With that, however, Dr. Kampel said the urgency of the disparities among Black men alters the equation. “I strongly recommend routine screening” for Black men starting at 40,’’ he said.
The chasm between Black and white patients, Dr. Kampel said, “is an absolutely startling number, and it just cries out for action to reduce that disparity.’’
—David Steele
