Well-documented racial inequities exist when it comes to prostate cancer. Extensive research has shown disparities in many measures, including screening, diagnostics, surveillance, and treatment. These disparities lead to significant inequities in clinical outcomes for prostate cancer patients. When it comes to dying from prostate cancer, black men face double the risk of white men.
Researchers have identified many factors leading to the difference in prostate cancer-related mortality rates between Black and White men. When treated appropriately, localized prostate cancer has high survival rates. However, studies suggest Black men remain far less likely to receive radical prostatectomy, the surgical removal of the entire prostate and surrounding tissue. Further, among those undergoing surgery, Black men have a longer time between diagnosis and treatment than White men. .
A recent study published in Cancer evaluated another factor influencing prostate cancer disparities between Black and White men: surgical volume. Surgical volume, defined as the number of times a hospital (or individual surgeon) has performed a surgery, such as a radical proctectomy, often correlates with outcomes related to that procedure.
The study included over 30,000 men, including about 2,000 Black men. Compared to White men, Black men had a younger age at diagnosis and lower socioeconomic status. In addition, Black men had a longer time between diagnosis and surgery. Clinical differences also existed; Black men had a higher prostate-specific antigen (PSA) and more comorbidities. All men in the study received Medicare health insurance benefits.
The researchers qualified surgical volume for individual surgeons and healthcare facilities for those enrolled in the study. The volumes for each category were ranked into percentiles (99.1%–100%, 95.1%–99%, 90.1%–95%, 75.1%–90%, 50%– 75%, and <50%). For perspective, the surgical volume of individual surgeons and facilities correlated to >21, 12–20, 8–11, 4–7, 2–3, and 1 and >42, 23–41, 15–22, 8–14, 3–7, 1–2, respectively.
When analyzing the impact of surgical volume on the patients in the study, the researchers found Black men significantly less likely to have a surgeon or facility in the top volume percentile. Black men receiving care from a low-volume surgeon or facility exhibited a greater risk of prostate cancer mortality. The analysis revealed a greater risk of prostate cancer mortality even after adjusting for differences between the populations, including age, PSA, and comorbidities.
The researchers reported other trends that could impact the quality of care between Black and White populations. For example, Black men appeared less likely to visit a National Cancer Institute-designated cancer center. More often than White men, Black men received care at a minority-serving hospital, defined as those admitting at least 33% of the patients indicating Hispanic or Black race/ethnicity. The study also suggests that White men have greater mobility when it comes to receiving treatment as Black men less often traveled more than 50 miles.
The study concludes that Black prostate cancer patients more commonly see surgeons and visit facilities with low surgical volumes. The authors suggest that these trends could negatively impact the quality of care these men receive and their outcomes following prostate cancer diagnosis and treatment. The study, therefore, indicates that increasing access to high-quality prostate cancer care could directly benefit racial disparities.
Sources: ASCO Educational Book, CA, Eur Urolog, Prostate Cancer Prostatic Dis, J Urolog, Cancer
