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Black Men With Advanced Prostate Cancer Lack Access to Best Treatments
Prostate cancer is a significant health concern for men worldwide. It is the second most common cancer in men, with over 1.4 million new cases diagnosed each year. While advancements in treatment options have improved outcomes for many patients, there is a disturbing disparity in access to the best treatments for black men with advanced prostate cancer.
The Disparity
Studies have shown that black men are more likely to develop prostate cancer and have a higher mortality rate compared to their white counterparts. This disparity is not fully understood, but it is clear that access to quality healthcare plays a significant role.
Black men with advanced prostate cancer often face barriers that prevent them from receiving the best available treatments. These barriers include limited access to healthcare facilities, financial constraints, and a lack of awareness about the latest treatment options.
Access to Healthcare Facilities
One of the primary reasons for the lack of access to the best treatments is the limited availability of healthcare facilities in underserved communities. Many black men living in these areas do not have easy access to specialized cancer centers or hospitals with the necessary resources to provide optimal care.
Furthermore, even when healthcare facilities are available, there may be a shortage of healthcare professionals with expertise in treating advanced prostate cancer. This shortage can lead to delays in diagnosis, inadequate treatment, and ultimately poorer outcomes for black men.
Financial Constraints
Financial constraints also contribute to the disparity in access to the best treatments for black men with advanced prostate cancer. Many black men may lack health insurance or have limited coverage, making it difficult to afford expensive treatments or travel to specialized healthcare facilities.
Furthermore, the cost of medications and therapies can be a significant burden for individuals without adequate insurance coverage. This financial strain often leads to treatment delays or suboptimal treatment choices, further exacerbating the disparities in outcomes.
Lack of Awareness
Another significant factor contributing to the lack of access to the best treatments is a lack of awareness among black men about the latest advancements in prostate cancer treatment. This lack of awareness can result from various factors, including limited health education, cultural barriers, and mistrust of the healthcare system.
It is crucial to address this issue by improving health education and increasing awareness of the available treatment options. By empowering black men with knowledge about their condition and the resources available to them, we can help bridge the gap in access to the best treatments.
Solutions and Recommendations
Addressing the disparities in access to the best treatments for black men with advanced prostate cancer requires a multi-faceted approach.
Firstly, there is a need to increase the availability of healthcare facilities in underserved communities. This can be achieved through targeted investments in infrastructure and the recruitment of healthcare professionals with expertise in treating prostate cancer.
Secondly, efforts should be made to improve health insurance coverage for black men, ensuring that they have access to affordable and comprehensive healthcare. This can be achieved through policy changes and increased funding for programs aimed at reducing healthcare disparities.
Lastly, education and awareness campaigns should be developed specifically targeting black men. These campaigns should focus on raising awareness about prostate cancer, its risk factors, and the available treatment options. By empowering black men with knowledge, we can help them make informed decisions about their healthcare.
Black men with advanced prostate cancer less likely to receive crucial treatment, study finds
A new study led by investigators at the UCLA Health Jonsson Comprehensive Cancer Center found Black men diagnosed with more advanced stages of prostate cancer are significantly less likely to be prescribed novel hormone therapy than other racial and ethnic groups—including white or Latino men—despite the therapy being proven to effectively control the growth of prostate tumors and extend the lives of men with the disease.
The findings, published in JAMA Network Open, reveal a concerning racial disparity in the utilization of the crucial therapy for the treatment of the disease.
“This revelation is particularly concerning given the already disproportionate impact of prostate cancer on Black men, who are 1.5 times more likely to be diagnosed and 2.4 times more likely to die from the disease than white men in the United States,” said co-senior study author Dr. Amar Kishan, professor of radiation oncology at the David Geffen School of Medicine at UCLA and a researcher at the UCLA Health Jonsson Comprehensive Cancer Center.
Novel hormonal therapy agents are the next generation of hormonal therapy that targets the androgen signaling axis, which plays a crucial role in the growth and progression of prostate cancer cells. Androgens, such as testosterone, stimulate the growth of prostate cancer. The hormonal therapy works by inhibiting the action of androgens or reducing their levels in the body.
They are also often used in combination with traditional androgen deprivation therapy to more effectively suppress androgen signaling, providing improved outcomes for patients with advanced or metastatic prostate cancer.
“Even though we know hormonal therapies have significant clinical benefits in men with more advanced stages of prostate cancer, there is not much information available about how often people in the general population use these drugs—particularly in the context of equitable access to these medications across different race and ethnicity groups,” said Dr. Michael Xiang, assistant clinical professor in radiation oncology at the David Geffen School of Medicine at UCLA and co-senior author of the study.
To look into how doctors prescribe these drugs based on the race and ethnicity of patients in the U.S., the team of researchers used data from a population-based cancer registry linked to prescription drug records for 3,748 Medicare beneficiaries with a median age of 75 with a diagnosis of advanced prostate cancer from 2011 to 2017. Among them, 8% were Black, 7% Hispanic, 78% white, and 7% from other racial and ethnic groups.
The majority of patients had metastatic prostate cancer, with 36% receiving novel hormone therapy. White patients had the highest two-year novel hormone therapy utilization rate at 27%, followed by Hispanic patients at 25% and other racial/ethnic groups at 23%. Black patients had the lowest rate at 20%.
This disparity persisted at five years and beyond, with Black patients consistently receiving this crucial treatment at a lower rate than their white counterparts. The researchers found Black men were 24% less likely to receive or be prescribed one of these novel hormonal therapy agents as compared to white men. By contrast, this disparity was not observed among Latino men or men of other racial and ethnic groups.
“Our findings raise critical questions regarding the reasons behind this inequality, suggesting possible obstacles to health care, financial burdens, and unconscious biases within the health care system,” said Xiang.
Future studies are needed to uncover underlying causes and to systematically address these issues for more equitable care, noted the authors.
The study’s first author is Dr. Ting Martin Ma, a former radiation oncology resident at the David Geffen School of Medicine at UCLA and currently an assistant professor of radiation oncology at University of Washington. Other UCLA authors include: Dr. Matthew Rettig, Dr. Luca Valle, Dr. Michael Steinberg and Dr. Isla Garraway.
More information: Ting Martin Ma et al, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.45906
Citation: Black men with advanced prostate cancer less likely to receive crucial treatment, study finds (2023, December 1) retrieved 9 December 2023 from https://medicalxpress.com/news/2023-12-black-men-advanced-prostate-cancer.html
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7 essential facts about prostate cancer Black men need to know
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Prostate cancer is a topic that affects men of all races and ethnicities, but it’s essential to recognize that certain groups face a higher risk than others. Among these, Black men are at an increased risk of developing prostate cancer and experiencing more aggressive forms of the disease. Let us explore seven crucial facts every Black man should know about prostate cancer and the steps they can take to protect their health.
Elevated Risk in Black Men
The first and most vital fact to understand is that Black men are at a significantly higher risk of developing prostate cancer compared to other racial and ethnic groups. According to the American Cancer Society, Black men have about a 1 in 7 chance of being diagnosed with prostate cancer during their lifetime, whereas the risk for white men is about 1 in 8. This higher risk factor makes prostate cancer a pressing concern for the Black community.
Earlier Onset
Not only do Black men have a higher risk of prostate cancer, but they also tend to develop the disease at a younger age. It’s not uncommon for Black men to receive a prostate cancer diagnosis several years earlier than their white counterparts. This earlier onset can have significant implications for treatment and outcomes, highlighting the importance of proactive screening and early detection.
Aggressive Forms of Prostate Cancer
In addition to a higher risk and earlier onset, Black men are more likely to develop aggressive forms of prostate cancer. These aggressive tumors tend to grow and spread more rapidly, making them more challenging to treat effectively. Early detection is crucial because it allows for more treatment options and better chances of successful outcomes.
Family History Matters
One of the key risk factors for prostate cancer is a family history of the disease. If you have a close relative, such as a father or brother, who has been diagnosed with prostate cancer, your risk increases significantly. This risk factor is particularly important for Black men, as they are more likely to have a family history of the disease. Knowing your family’s medical history can help you and your healthcare provider make informed decisions about screening and preventive measures.
Regular Screening Saves Lives
Regular prostate cancer screening is essential for all men but especially critical for Black men due to their increased risk. Screening typically involves a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). These tests can detect prostate cancer at an early stage, often before symptoms appear. While there is some controversy surrounding the PSA test’s accuracy and overdiagnosis, it remains a valuable tool for identifying potential issues. Discuss the benefits and risks of screening with your healthcare provider to make an informed decision based on your individual risk profile.
Lifestyle and Diet Matter
Maintaining a healthy lifestyle can play a significant role in reducing your risk of developing prostate cancer. While genetics and family history are factors you can’t control, you can take steps to lower your risk. A balanced diet rich in fruits, vegetables, and whole grains, along with regular physical activity, can help lower your risk. Some studies suggest that a diet low in saturated fats and high in antioxidants may be particularly beneficial. Additionally, limiting alcohol consumption and not smoking can contribute to a healthier prostate.
Treatment Options and Support
In the unfortunate event that you or a loved one is diagnosed with prostate cancer, it’s essential to be informed about available treatment options and support resources. Treatment approaches for prostate cancer can vary based on the stage of the disease, its aggressiveness, and your overall health. Options may include surgery, radiation therapy, hormone therapy, chemotherapy, or active surveillance (watchful waiting). Your healthcare team will work with you to develop a personalized treatment plan that aligns with your goals and preferences.
Support is also crucial during your prostate cancer journey. Many organizations and support groups offer information, resources, and emotional support for individuals and families affected by prostate cancer. Connecting with others who have gone through similar experiences can provide valuable insights and comfort during a challenging time.
Prostate cancer is a significant health concern for Black men due to their higher risk, earlier onset, and increased likelihood of developing aggressive forms of the disease. However, being informed and proactive about your prostate health can make a substantial difference.
As a Black man, it’s essential to prioritize your health and take action to protect yourself from the risks associated with prostate cancer. Discuss your concerns with your healthcare provider, engage in open and honest conversations about screening and prevention, and lean on the support of your community and loved ones during your journey toward maintaining a healthy prostate.
This story was created using AI technology.
Current and Emerging Treatments in the Management of Castration-Resistant Prostate Cancer
Approved Treatments for CRPC
The four treatments approved for use in patients with CRPC include docetaxel plus prednisone, cabazitaxel, abiraterone acetate and sipuleucel-T. This section will review the findings of landmark studies that led to FDA approval of each agent and highlight some of the advantages and adverse effects of each modality (Table 1).
Docetaxel Plus Prednisone
Prior to 2004, treatment for CRPC was typically palliative, with an expected survival of 6–12 months.[26,27] The only chemotherapy regimen used in patients with CRPC was mitoxantrone plus prednisone. This regimen improved the quality of life but did not provide a survival benefit.[28] In 2004, two landmark randomized-controlled trials demonstrated that treating patients with docetaxel-based chemotherapy (an inhibitor of microtubule depolymerization) provided a survival benefit for these patients. The TAX 327 study found that men given docetaxel and prednisone (D/P) lived a median of 2.4 months longer and reported improved pain control and better quality of life compared with patients treated with mitoxantrone and prednisone.[29] The SWOG-9916 trial obtained similar results with a slightly different regimen of docetaxel and estramustine.[30] Common toxicities reported by at least 15% of patients on docetaxel included alopecia, diarrhea, peripheral neuropathy, peripheral edema and dyspnea. In summary, these two large studies disproved the notion than CRPC was refractory to chemotherapy and led to the approval of the D/P combination as the first-line treatment for patients with CRPC.
In 2007, Armstrong et al. designed a prognostic model using baseline variables from subjects of the TAX 327 study to predict death among men with metastatic CRPC. The model utilizes ten variables of the patient’s cancer parameters, various markers, and quality of life to allow the clinician to make an estimate of the patient’s survival duration.[31] This model is useful in making clinical prognostications and providing patients more personalized statistics. It may also prove useful in considering additional approved or experimental therapies at earlier points during docetaxel treatment.
Cabazitaxel (Jevtana®, Sanofi-Aventis, NJ, USA) is a potent inhibitor of microtubule depolymerization that, unlike docetaxel, is resistant to P-glycoprotein, an ATP-dependent drug efflux pump that can sometimes be expressed by cancer cells. Preclinical and clinical trials revealed that cabazitaxel demonstrated activity in patients with known docetaxel-resistant CRPC.[32] The TROPIC (a Phase III) trial compared cabazitaxel with mitoxantrone in 735 men with CRPC whose cancer had progressed despite having been previously treated with docetaxel-based chemotherapy. The median survival time was 2.4 months greater for the patients treated with cabazitaxel compared with those given mitoxantrone. Cabazitaxel usage also resulted in higher rates of PSA reduction and tumor response compared with mitoxantrone. However, compared with patients given mitoxantrone, those given cabazitaxel had a higher risk of death within 30 days of the last dose of the drug, which was attributable to neutropenia, a side effect seen in 94% of patients receiving cabazitaxel (82% of cases were grade 3 or higher).[33] Therefore, any patient given this agent should be monitored appropriately, especially men at high risk for neutropenic complications. Other common side effects include diarrhea (47%), fatigue (37%) and nausea (34%). In June 2010, cabazitaxel was the first chemotherapy drug approved by the FDA for use in patients with metastatic CRPC refractory to docetaxel-based chemotherapy. An additional Phase III trial will evaluate cabazitaxel versus docetaxel as a first-line treatment for metastatic CRPC.
Abiraterone acetate (AA; Zytiga®, Janssen Biotech, PA, USA)) and its metabolite, abiraterone, are highly selective, potent irreversible inhibitors of CYP17A1 enzymes 17α-hydroxylase (an unintended target of the drug; an enzyme that plays no role in inhibiting cancer cell proliferation but is necessary for cortisol production) and C17,20-lyase (the desired target of the drug; necessary for production of androgens that enable prostate cancer cell proliferation).[34,35] It has a similar mechanism of action to ketoconazole but is approximately ten times more potent. Ketoconazole is a drug that has demonstrated anti-tumor activity and was used to treat CRPC for over 30 years, but was withdrawn from clinical use because of its short half-life and side effects secondary to its nonselectivity.[36]
A recent Phase III trial of post-docetaxel CRPC patients found that patients subsequently treated with AA experienced a greater overall survival of 3.9 months compared with those receiving placebo. All secondary end points, including progression-free survival and PSA response rate (defined as the proportion of patients with a decrease ≥50% from pretreatment) favored the treatment group as well. Since the results at interim analysis exceeded pre-planned criteria for study termination, the study was terminated early and patients in the placebo group were offered AA if they met appropriate criteria.[37] The most common adverse events, which were primarily grade 1 and 2 events, included back pain (30%), nausea (30%), constipation (26%), bone pain (25%) and arthralgias (27%). Additionally, adverse events associated with 17α-hydroxylase blockade included those of mineralocorticoid excess (edema, hypokalemia and hypertension), cardiac disorders and liver function test abnormalities. Grade ≥3 side effects experienced by patients were minimal in Phase II and III trials of the agent, and the most common adverse events, fatigue and anemia, occurred less than 10% of the time.[37–39] AA was approved by the FDA for use in post-docetaxel CRPC in April 2011.
The success of an oral agent in this patient population has led many to question whether it could successfully be used prior to the use of chemotherapy. COU-AA-302 is an ongoing Phase III trial seeking to determine the efficacy of AA in treating chemotherapy-naive patients with advanced prostate cancer.[101] Experimental therapies TAK-700 and VT-464 have higher affinities for C17,20-lyase than 17α-hydroxylase compared with AA, and early clinical data suggest they may have greater efficacy with a more tolerable side effect profile than AA.
Sipuleucel-T (Provenge®, Dendreon Corporation, WA, USA) was the first autologous immunotherapy approved for any cancer. It is an active cellular immunotherapy: a type of therapeutic cancer vaccine[40] designed to stimulate T-cell immunity against prostatic acid phosphatase, an antigen expressed on the surface of prostate cancer tumor cells.[20,40]
Integrated data from the first two randomized, placebo-controlled Phase III clinical trials of sipuleucel-T given to patients with advanced prostate cancer found that the median time for survival for patients on the drug improved by 4.3 months compared with patients on placebo (p = 0.11; CI: 1.10–2.05). There was no significant difference in time to progression for patients on sipuleucel-T (11.1 weeks) versus placebo (9.7). Despite this, the investigators concluded that sipuleucel-T imbued a survival advantage to patients with metastatic CRPC.[20,21] These favorable results led to the FDA approval of sipuleucel-T to treat asymptomatic or minimally symptomatic metastatic CRPC.
The most recent Phase III trial obtained similar statistically significant results: patients receiving sipuleucel-T lived 4.1 months longer than patients on placebo (25.4 vs 21.7 months), with no difference in time to progression between experimental and placebo arms of the study (14.6 vs 14.4 weeks). Most side effects of the drug occurred within 1 day of infusion and typically resolved within 1–2 days. They included chills (51.2%), fever (22.5%), fatigue (16.0%), nausea (14.2%) and headache (10.2%).[19] These side effects are more tolerable than those experienced by patients given the alternative traditional cytotoxic chemotherapy regimen, which include nausea, vomiting, diarrhea, fatigue, alopecia, myelosuppression and peripheral neuropathy.
Conclusion
The lack of access to the best treatments for black men with advanced prostate cancer is a significant healthcare disparity that needs to be addressed. By improving access to healthcare facilities, addressing financial constraints, and increasing awareness, we can help bridge the gap and ensure that all men have equal opportunities for optimal prostate cancer treatment.
It is essential for policymakers, healthcare providers, and communities to come together and work towards eliminating these disparities. Every man, regardless of his race or socioeconomic status, deserves the best possible care when facing advanced prostate cancer.
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