Black men cite lack of invitation, information as key barriers to prostate cancer trials

Black men cited not being asked to participate in prostate cancer clinical trials as the primary reason for not joining them, according to a recent survey conducted by the Prostate Health Education Network (PHEN).¹

The findings were published in Urology Practice.

Keith Crawford, MD, PhD

"Prostate cancer patients can gain life-saving treatments from clinical trials," said lead author Keith Crawford, MD, PhD, the PHEN Director of Clinical Trials and Patient Education, in a news release on the findings.² "A key goal for PHEN is to increase African American participation in clinical trials. Tailored clinical trials have the potential to transform prostate cancer care, decreasing side effects and improving the overall quality of life for each patient."

For the study, PHEN members were contacted by email to complete a 21-question survey on participation in prostate cancer clinical trials. The survey was sent to 480 members of PHEN, of whom 115 (24%) completed the survey. Members were eligible to participate if they were US-based Black men who had received a diagnosis of prostate cancer.

According to the authors, “Respondents were diverse in age, geography, education, and socioeconomic status, and 58 (50.4%) had a family history of prostate cancer.” The majority of respondents presented with localized prostate cancer at diagnosis.

Among the 115 respondents, 10.4% (n = 12) had participated in a prostate cancer clinical trial. All of those who had participated reported a satisfactory experience. Further, 75% said that they perceived the trial as advancing medical science, and 66.7% said that the perceived the trial as providing them with an effective treatment or diagnostic option.

Of those who had not taken part in a trial, the top reasons for lack of participation were not being asked (55.1%) and a lack of information regarding the risks and benefits of participation (13.5%).

Although no participants cited a lack of trust in the health care system based on personal experience as a reason for non-participation, 2.2% (n = 2) said they did not participate due to a lack of trust based on history (the Tuskegee study).

“Possible reasons why health care providers do not ask Black males about participation in prostate cancer clinical trials include lack of awareness of suitable trials, incorrect assumptions that patients will be concerned about the Tuskegee study, or that comorbidities will preclude participation,” the authors wrote.

When asked what might encourage future trial participation, the top answers by respondents were whether they perceived the treatment or diagnostic to be effective (54.5%), whether the trial had the potential to advance medical side effects (45.5%), and if there was a minimal potential for side effects (44.4%). Further, 89.7% of respondents said it was important for a prostate cancer clinical research team to have staff that took time to explain study procedures, risks, and benefits, and 56.7% of respondents said it was important that they be confident in the skills and knowledge of the staff.

The authors added, “Racial diversity among trial investigators was also important to patients, and physicians being of the same racial group as the patient was cited by some respondents to the survey as an important quality of a clinical research team.”

In interpreting these results, the authors referenced a key finding from a 2021 study showing that when offered the chance to participate in a cancer clinical trial, Black patients participated at a similar rate to White patients (58.4% vs 55.1%; P = .88).³ This finding, coupled with the results of the current survey, emphasize the need to more effectively communicate opportunities for trial involvement for Black men.

Overall, the authors concluded, “We call for stronger collaboration between patients, health professionals, the pharmaceutical industry, and clinical trial investigators. Engaging target communities in discussions about the value of clinical trial enrollment is key to creating inclusive clinical trial populations and can be accomplished through outreach strategies involving, for example, church and advocacy groups.”

References

1. Crawford K, Vinson J, Farrington T. Identification of factors affecting the accrual of Black males into prostate cancer clinical trials in the United States. Urol Pract. 2025;12(1):51-61. doi:10.1097/UPJ.0000000000000726

2. AUA's Urology Practice publishes PHEN's peer-reviewed study: Black men not being asked to participate in prostate cancer clinical trials. News release. Prostate Health Education Network. Published online and accessed January 27, 2025. https://www.prnewswire.com/news-releases/auas-urology-practice-publishes-phens-peer-reviewed-study-black-men-not-being-asked-to-participate-in-prostate-cancer-clinical-trials-302359844.html

3. Unger JM, Hershman DL, Till C, et al. "When Offered to Participate": A Systematic Review and Meta-Analysis of Patient Agreement to Participate in Cancer Clinical Trials. J Natl Cancer Inst. 2021;113(3):244-257. doi:10.1093/jnci/djaa155