Prostate cancer diagnosis and management equal for Black and White men in UK
MedWire News: Results of a UK-based study have shown no evidence of differences in prostate cancer characteristics at diagnosis or disease management between Black men and White men.
Recent US-based research has suggested a poorer prognosis in Black men, say researchers who hypothesized that ethnic differences would be less apparent in the UK on account of free healthcare.
Yoav Ben-Shlomo (University of Bristol) and colleagues explain that in the USA, “on average, Black men occupy less privileged socioeconomic positions and… access to health services is largely determined by the patient’s ability to pay.”
“Hence, the poorer prognosis in Black men is not necessarily due to a more aggressive disease type,” they suggest in the British Journal of Cancer.
Ben-Shlomo and team analyzed data on ethnicity, prognostic factors, and clinical care from a cohort of 473 Black men and 988 White men involved in the Prostate Conditions in Ethnic Subgroups (PROCESS) study. A Delphi sub-study investigated the appropriate use of diagnostic investigations and management strategies.
At diagnosis, cancer stage was very similar between Black and White men, with approximately 75% of both groups diagnosed with localized disease. Gleason scores in Black and White men were also comparable, at 55% versus 56%, 24% versus 22%, and 21% versus 22%, respectively, for Gleason scores of 6 or less, 7, and 8–10.
Overall, prostate-specific antigen (PSA) levels were similar at diagnosis in both ethnicities, at 25 ng/ml for Black men and 23 ng/ml for White men. However, after age-adjusted analysis, Black men had on average 1.4-fold higher PSA levels than White men.
Regarding treatment, Black men were 1.50 times more likely than White men to undergo a bone scan, and 1.33 times more likely to undergo a CT scan, but further analysis suggested this was because Black men were diagnosed at a younger age than White men (67.9 years vs 73.3 years).
Furthermore, younger age at diagnosis also accounted for Black men being 1.57 times more likely than White men to undergo a curative treatment strategy such as surgery or radiotherapy.
The results of the Delphi analysis suggested no difference in disease management by ethnicity. For example, no surgical cases were deemed inappropriate among Black men, and only two among White men, while 15 were deemed equivocal among Black men and 13 among White men, and 53 cases were deemed appropriate in Black men compared with 47 in White men.
“This comparability between the experiences of Black men and White men… will assist interpretation when comparing survival between Black men and White men after a diagnosis of prostate cancer,” conclude Ben-Shlomo et al.
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By Sarah Guy