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Black men are 70% more likely to be diagnosed with prostate cancer than white men, according to a report from the American Cancer Society. This is one of the largest disparities in cancer incidence and mortality.
1 in 6 Black men will be diagnosed with prostate cancer in his lifetime.
Dr. Arnold Bullock, an Alan A. & Edith L. Wolff Distinguished Professor in Urology at Washington University, says mortality rates for prostate cancer depend on where you live in the St. Louis region.
“It’s amazing how different the prostate cancer numbers are based on what zip codes you’re in a lot of major metropolitan cities across the country. There is a big difference in mortality rate or death rate based on your zip code,” Dr. Bullock said.
According to Dr. Bullock, if you live in the 63136 zip code, one has a “fivefold greater chance” or prostate cancer death compared to an individual who lives in the 63110 zip code. He goes on to explain why this is happening.
“In North County, there’s a higher percentage of African Americans, and African Americans have the highest rate of prostate cancer in the world, so in general, Blacks get prostate cancer diagnosed at two times the rate of whites, but that still doesn’t account for the higher mortality rate,” he said.
“The mortality rate is based on what stage of diagnosis, so unfortunately, there’s less screening for prostate cancer in the Black population than in the white population.”
The persistent problem in preventing or catching prostate cancer early enough to treat it in time, is screenings, according to experts like Dr. Bullock.
“If you have a population that’s more likely to get prostate cancer for unknown reasons anyway, and then you screen that population less, you’re going to end up with higher stage disease at the time of diagnosis, and the higher the stage or better stated, the more likely your cancer is already spread at the time of diagnosis, the more likely you die,” he explained.
From a historical standpoint, before prostate-specific antigen (PSA) screenings were available, two thirds of prostate cancer had spread by the time African Americans were diagnosed in the ‘50’s. By the ‘80s, one third of white Americans had cancer spread by the time they were diagnosed with the disease. However, these rates dropped in the mid-‘90s.
“By the mid-‘90s with PSA screenings, that rate had dropped down to less than 8% of Blacks and less than 2% of Whites had cancer spread at the time of diagnosis, so your chances of being diagnosed with localized cancer, curable cancer is based on your screening,” Dr. Bullock said. “In 2012, the US Preventive Task Force suggested that screenings did more harm than good, which makes no sense, but this is the same task force that suggested that women don’t need mammograms at such an early age.”
According to the urologist, these recommendations have a direct impact on people’s lives.
“Between 2012 and 2018, the percentage of Blacks who were screened for cancer dropped dramatically, and you would say, well it should have dropped in the whites, but just because the recommendation changed in some populations, that doesn’t mean the practice of the doctors changed, so in more well-to-do areas they continue to screen and in less well-to-do areas they quit screening,” he said.
When asked what’s being done to combat the lack of prostate cancer screenings, Dr. Bullock talked about the community outreach being done by him, his colleagues, and local health groups.
“We, including Dr. Lannis Hall who is a radiation oncologist, the members of the prostate Cancer Coalition, the Siteman Cancer Center and many other groups including the Empowerment Network and the Prostate Cancer Support Group, try to go into the community, churches and men’s groups to educate community on the fact that prostate cancer is a deadly disease” he said.
“Prostate cancer is the second leading cause of cancer death in men, only behind lung cancer, and we can change that number through screening, but we must keep pushing this subject in community events like today.”
Pfizer and their questionable solution
Pfizer recently released a study on the combination of Talzenna/Xtandi to treat prostate cancer at the American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium.
Data from the Pfizer study showed a 37% reduction in risk of disease progression or death in men with metastatic castration-resistant prostate cancer treated with TALZENNA plus XTANDI, their proposed treatment.
Dr. Aida Habtezion, Chief Medical Officer and head of Worldwide Medical and Safety at Pfizer, talked about the new drug that could be a game changer in treating prostate cancer.
“For reasons that we do not understand, there is a clear increase in terms of prostate cancer, diagnosis and also its incidents, certainly over the past decade there has been incredible amount of work that has led to better ways to diagnose the disease and also to treat the disease,” said Dr. Aida Habtezion, Chief Medical Officer, and head of Worldwide Medical and Safety at Pfizer
According to data from the CDC, cases of advanced prostate cancer are on the rise for the first time in 20 years.
“We know that African ancestry also is a risk. Factor for prostate cancer and the development of more late stage aggressive cancers,” Dr. Habtezion said. “I think as I mentioned why this disparity exists is we can think about access barriers because, regardless of race, if they could be diagnosed early, the outcome could be similar among the different ethnic groups.”
When asked about demographics and how many Black men participated in the study, a representative from Pfizer followed up by email to say “Unfortunately, that information is not publicly available. Other than confirm that there were Black participants in both arms of the study, I am afraid there is no further details we can provide at this time.”
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