Study Explores Why Prostate Cancer Mortality is Higher in Black Men

The largest study of its kind finds societal factors and access to quality care, rather than genetics, underlies higher prostate cancer mortality rates for black men.

11:50 AM

Author | Jordyn Imhoff

people

Black men are more likely to be diagnosed with prostate cancer and nearly 2.5 times more likely to die of the disease compared to non-Hispanic white men. The question is why. Are black men more likely to carry genes that drive deadlier forms of the disease? What societal disparities might be affecting outcomes?

In a new JAMA Oncology study, a team led by the U-M Rogel Cancer Center analyzed data from more than 300,000 prostate cancer patients in order to better understand outcomes and what factors might be driving them.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily audio updates on iTunes, Google Play and Stitcher.

For example, in addition to their prostate cancer diagnosis, black men were more likely to have cardiovascular disease and obesity, which can separately shorten their lifespans, says study co-senior author Daniel Spratt, M.D., co-Chair of Genitourinary Clinical Research at U-M.

"The data show that black men don't appear to intrinsically and biologically harbor more aggressive disease," Spratt says. "They generally get fewer PSA screenings, are more likely to be diagnosed with later stage cancer, are less likely to have health insurance, have less access to high-quality care and other disparities that can be linked to a lower overall socioeconomic status."

Spratt adds, "While our job is to treat cancer, we know that these other factors are in play, so as doctors we need to make sure we focus on the health of the entire patient and, as a society, on addressing racial inequities."

Better data

In the largest and most comprehensive study of its kind, the researchers assessed data from a large, population-based cohort from the National Cancer Institute, as well as multi-center data from the Veteran's Affairs heath system and data from four randomized clinical trials sponsored by the National Cancer Institute.

Black men don't intrinsically and biologically harbor more aggressive disease.
Daniel Spratt, MD

The large, population-based dataset — known as Surveillance, Epidemiology, and End Results, or SEER — had previously been used to suggest that there were underlying genetic factors behind differences in outcomes seen in blacks and whites in the US, since the data didn't account for multiple variables.

The additional data and analysis in the U-M study suggest external factors are more likely the cause, the researchers say.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

Using patients from the VA allowed the researcher to look at a group with more similar baseline characteristics, one that has equal access to healthcare, the authors note. Additionally, in the randomized trial data, comparison is improved because patients are given specified treatment regimens and have regular follow-up, often for more than 10 years.

Looking across all of these datasets provides a more accurate picture of whether race, independent of other social factors, leads to different health outcomes.

Conclusions

The study's researchers found that black men did not have an increased risk of dying from prostate cancer compared to white men with a similar stage of disease. On a population level, the disparities in death rates appear to mostly, if not entirely, be attributed to external circumstances.

However, even when adjusting for variables, it was clear across the three datasets that black men die more often from other causes like heart disease compared to white men. Therefore, the greatest disparity to black men with prostate cancer is access to quality healthcare and guideline concordant care that are likely rooted in complex socio-cultural inequities in the US.

The clinical trials data even suggested that black men had a lower prostate cancer mortality rate than white men — meaning that on a stage-for-stage basis black men might have higher cure rates than white men when treated with radiation therapy. So, Spratt encourages providers to be cautious about misinterpreting the SEER population results updated each year.

"Why black men are diagnosed more often with prostate cancer is something that requires further investigation," he says.

The study was co-led by first authors: Robert Dess, MD, Holly Hartman, MS, from U-M and Brandon Mahal, MD, from Masschusetts General Hospital. The other co-senior author was Matthew Schipper, PhD, from U-M.

Conflict of Interest Disclosure: Daniel Spratt reported receiving personal fees from Janssen Pharmaceuticals and Blue Earth outside the submitted work.


More Articles About: Lab Report Prostate Cancer Basic Science and Laboratory Research Cancer Research Race and Ethnicity Cancer: Cancer Types
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Illustration of hand holding list, with pill bottle in opposite and and small pic of doctor talking to patient
Health Lab
New urine-based test detects high grade prostate cancer, helping men avoid unnecessary biopsies
A new urine-based test addresses a major problem in prostate cancer: how to separate the slow growing form of the disease unlikely to cause harm from more aggressive cancer that needs immediate treatment.
Illustration of a microscope
Health Lab
Helpful enzymes vanish in many patients with antiphospholipid syndrome
Researchers recently revealed a new mechanism behind antiphospholipid syndrome that the investigators hope will eventually allow treatments to be targeted closer to the source of the problem.
Florescent image of a human ovarian follicle
Health Lab
Spatial atlas of the human ovary with cell-level resolution will bolster reproductive research
New map of the ovary provides a deeper understanding of how oocytes interact with the surrounding cells during the normal maturation process, and how the function of the follicles may break down in aging or fertility related diseases.
A CT scan of healthy lungs
Health Lab
Study reveals potential to reverse lung fibrosis using the body’s own healing technique
A recent U-M study uncovers a pathway utilized during normal wound healing that has the potential to reverse idiopathic pulmonary fibrosis.
Blue image of a microscopic helix strand
Health Lab
Researchers discover urine based test to detect head and neck cancer
At-home test can detect tumor DNA fragments in urine samples, providing a non-invasive alternative to traditional blood-based biomarker tests
Close up image of red blood cells moving through veins
Health Lab
Discovery reveals how this common stinky gas is processed to promote blood vessel growth
A new collaborative study, examined the interaction between three naturally occurring gases — nitric oxide (NO), oxygen, and H2S — during generation of new blood vessels, called angiogenesis.