TAMPA — African-American men are disproportionately affected by prostate cancer, but it remains unclear whether racial and ethnic disparities occur in equal-access settings at the national level.
Noting that the VA healthcare system offers a setting of relatively equal access to care in which to assess racial and ethnic disparities in self-identified African American (or Black) veterans and white veterans, researchers from the H. Lee Moffitt Cancer Center & Research Institute and the James A. Haley Veterans Hospital, both in Tampa, and colleagues sought to answer that question.
Their objective was to determine how much disparity occurs in the incidence of PCa, clinical stage and outcomes between African-American patients and white patients who received a diagnosis or were treated at a VA hospital. Results were published in JAMA Network Open.1
The retrospective cohort study included information on nearly 7.9 million veterans undergoing routine care in VA hospitals nationwide from 2005 through 2019 (incidence cohort). Researchers estimated the age-adjusted incidence of localized and de novo metastatic PCa, while also evaluating treatment response. Ca-specific outcomes were compared between African American and white veterans.
The time to distant metastasis following PCa diagnosis was defined as the primary outcome, and data from 92,269 veterans with localized PCa were used to assess treatment response.
Results indicate that the group of 28,802 African American men, who made up 31% of the case, tended to be younger (median [IQR], 63 [58-68] vs 65 [62-71] years) and had higher prostate-specific antigen levels (>20 ng/mL) at the time of diagnosis compared with the 69% of white men.
“Consistent with US population-level data, African American veterans displayed a nearly 2-fold greater incidence of localized and de novo metastatic PCa compared with white men across VA centers nationwide,” the authors advised. “Among veterans screened for PCa, African American men had a 29% increased risk of PCa detection on a diagnostic prostate biopsy compared with white (hazard ratio, 1.29; 95% CI, 1.27-1.31; P < 0.001). African American men who received definitive primary treatment of PCa experienced a lower risk of metastasis (hazard ratio, 0.89; 95% CI, 0.83-0.95; P < .001). However, African American men who were classified as “other” race and received treatment were more likely to develop metastasis (adjusted hazard ratio, 1.29; 95% CI, 1.17-1.42; P < 0.001).”
The researchers pointed out that, using the actual rate of metastasis from veterans who received definitive primary treatment, they observed a persistent residual metastatic burden for African American men across all National Comprehensive Cancer Network risk groups (low risk, 4 vs. 2 per 100,000; intermediate risk, 13 vs. 6 per 100 000; high risk, 19 vs. 9 per 100 000).
“This cohort analysis found significant disparities in the incidence of localized and metastatic PCa between African American veterans and White veterans,” the authors concluded. “This increased incidence is a major factor associated with the residual disparity in PCa metastasis observed in African American veterans compared with white veterans despite their nearly equal response to treatment.”
- Yamoah K, Lee KM, Awasthi S, Alba PR, et. al. Racial and Ethnic Disparities in Prostate Cancer Outcomes in the Veterans Affairs Health Care System. JAMA Netw Open. 2022 Jan 4;5(1):e2144027. doi: 10.1001/jamanetworkopen.2021.44027. PMID: 35040965; PMCID: PMC8767437.
