Study: Prostate cancer incidence nearly 2-fold higher in Black vs White men

Results of a retrospective study found that Black veterans had a nearly 2-fold greater incidence of prostate cancer (both localized and de novo metastatic disease) compared with White men.¹

In this study, published in JAMA Network Open, investigators used data from the Veterans Affairs (VA) national electronic health record in the Corporate Data Warehouse and the VA Central Cancer Registry. All patients in this population had received routine care at VA medical centers across the country between 2005 and 2019 (incidence cohort). Routine care was defined as at least 2 or more clinical encounters, regardless of prostate cancer status.

Kosj Yamoah, MD

“The VA provides high-quality care to veterans regardless of race, sex, geographic location, or economic circumstance, thereby creating an equal access system compared to other large health care systems,” Kosj Yamoah, MD, director of Radiation Oncology Cancer Health Disparities Research and section head of Genitourinary Oncology within the Department of Radiation Oncology at Moffitt Cancer Center, Tampa, Florida, said in a news release.² “This provides us with a unique environment to investigate prostate cancer health disparities across the disease continuum, such as treatment response or overall outcomes at each phase of the disease.”

Of the 7,889,984 Black and White veterans included in this study, 2,788,003 patients underwent prostate-specific antigen (PSA) testing, and 92,269 patients received a diagnosis of prostate cancer between 2005 and 2015 (MO cohort).

After investigators determined the age-adjusted incidence of localized and de novo metastatic prostate cancer, they used multivariable logistic regression to evaluate the relationship between race and ethnicity and pretreatment clinical variables. In addition, they used multivariable Cox proportional hazard models to estimate the risk of metastasis.

The primary outcome was time to distant metastatis after prostate cancer diagnosis. This measured treatment response was compared between Black and White veterans.

According to findings analyzed by the Moffitt Cancer Center, Black men (n=28,802 [31%]) in the MO cohort were younger (median [IQR], 63 [58-68] vs 65 [62-71] years) than White men (n=63,476; [69%]) and had higher PSA levels at the time of diagnosis (>20 ng/mL).

Black men were almost 2 times more likely to be diagnosed with prostate cancer than White men. This remained consistent across VA centers nationwide.

“Increased incidence of prostate cancer is a major driver of the residual disparity in prostate cancer metastasis among African American men. Even in an equal access to care scenario, we saw that adequate, timely therapy is a big factor that will decrease the risk of adverse events, including metastases and death,” Yamoah said.

Results also showed that Black men were 29% more likely to be diagnosed with prostate cancer using a diagnostic prostate biopsy vs White men (hazard ratio, 1.29; 95% CI, 1.27-1.31; P <. 001). Although Black men who received treatment for prostate cancer experienced a lower risk of metastasis (hazard ratio, 0.89; 95% CI, 0.83-0.95; P < .001), Black men who were identified as “other” race and received treatment were more likely to develop metastasis (adjusted hazard ratio 1.29; 95% CI, 1.17-1.42; P < .001).

Furthermore, a persistent residual metastatic burden for Black men was observed across all National Comprehensive Cancer Network risk groups. In the low-risk group, 4 Black men experienced this burden per 100,000 vs 2 White men. In the intermediate-risk group, 13 vs 6, respectively. In the high-risk cohort, 19 vs 9, respectively.

To the authors’ knowledge, this was the largest study to investigate racial and ethnic disparities across the range of prostate cancer statuses in an equal-access VA setting.

“There is a lot of work still to be done,” Yamoah concluded, “but this data gives us the information we need to develop strategies to combat prostate cancer disparities here in the U.S. and globally.”

References

1. Yamoah K, Lee KM, Awasthi S, et al. Racial and ethnic disparities in prostate cancer outcomes in the Veterans Affairs health care system. JAMA Network Open. 2022;5(1):e2144027. doi:10.1001/jamanetworkopen.2021.44027

2. Moffitt researchers analyze VA data to study prostate cancer disparities. H. Lee Moffitt Cancer Center & Research Institute. January 18, 2022. Accessed January 19, 2022. https://www.eurekalert.org/news-releases/940447