Bad sociology.
Top Line: Minds were blown at ASTRO 2018 with the novel concept that black men don’t inherently have worse prostate cancer biology.
The Study: As a reminder, the conventional wisdom that black men have worse prostate cancer prognoses comes from the fact that they die more often from their prostate cancers. Not unrelated to this is the fact that black men are sorely underrepresented in prostate cancer clinical trial data. So perhaps it is disparities in access to care—not in biology—that are driving worse outcomes. Cue this massive database study pooling data from the heavy hitters SEER, the VA, and RTOG phase 3 studies. Among >300K men with available details regarding their non-metastatic prostate cancer and its treatment, roughly 55K (18%) were black. Looking simply at the age-adjusted SEER cohort, an unsurprising hazard ratio (HR) of 1.3 for prostate cancer death in black versus white men emerged. However, black men also had significantly lower composite scores of income, housing, occupation, education, and insurance. When adjusting for these common barriers to care as well as for cancer and treatment specifics, that HR fell to <1.1 in the SEER cohort (with the least standardized treatment) and was 0.85 for the VA cohort (with presumably fairly standardized treatment). And, alas, when pooling outcomes from phase 3 RTOG trials (with rigorously standardized treatment), prostate cancer death was significantly lower for black versus white men with a HR of 0.8.
Bottom Line: Black men suffer from worse prostate cancer sociology. | Dess, JAMA Oncol 2019
The Study: As a reminder, the conventional wisdom that black men have worse prostate cancer prognoses comes from the fact that they die more often from their prostate cancers. Not unrelated to this is the fact that black men are sorely underrepresented in prostate cancer clinical trial data. So perhaps it is disparities in access to care—not in biology—that are driving worse outcomes. Cue this massive database study pooling data from the heavy hitters SEER, the VA, and RTOG phase 3 studies. Among >300K men with available details regarding their non-metastatic prostate cancer and its treatment, roughly 55K (18%) were black. Looking simply at the age-adjusted SEER cohort, an unsurprising hazard ratio (HR) of 1.3 for prostate cancer death in black versus white men emerged. However, black men also had significantly lower composite scores of income, housing, occupation, education, and insurance. When adjusting for these common barriers to care as well as for cancer and treatment specifics, that HR fell to <1.1 in the SEER cohort (with the least standardized treatment) and was 0.85 for the VA cohort (with presumably fairly standardized treatment). And, alas, when pooling outcomes from phase 3 RTOG trials (with rigorously standardized treatment), prostate cancer death was significantly lower for black versus white men with a HR of 0.8.
Bottom Line: Black men suffer from worse prostate cancer sociology. | Dess, JAMA Oncol 2019
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