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Black men in the United States are more likely to die of prostate cancer. This study looked at registry data, an equal-access health system and randomised trials together, and found that once treatment and access were equal, the difference in prostate cancer deaths largely disappeared. The difference in dying of everything else did not.
Robert Dess, Daniel Spratt and colleagues assembled individual patient data on men with clinical T1 to T4, N0 to N1, M0 prostate cancer from three cohorts with progressively tighter control of access: the Surveillance, Epidemiology, and End Results registry (296,273 men), five equal-access Veterans Affairs medical centres (3,972 men, all treated surgically) and four pooled National Cancer Institute randomised radiotherapy trials (5,854 men). Inverse probability weighting was used to adjust for demographic, cancer and treatment differences.
The gradient across the three cohorts is the finding. In the registry, Black race carried an age-adjusted subdistribution hazard ratio for prostate cancer death of 1.30; after adjustment it fell to 1.09, with no significant difference in high-risk men. In the equal-access surgical cohort there was no significant difference, and in the randomised trials Black men had a significantly lower hazard. Other-cause mortality remained significantly higher in two of the three cohorts.
The disparity in prostate cancer death among Black men in the United States is, stage for stage and treatment for treatment, largely a disparity in getting standard care rather than in tumour biology. The disparity that survives equal access is in dying of everything else, which is the part a cancer service is least organised to fix and most able to measure.
Shares Other-cause mortality, Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity, Hazard ratio (HR), Survivorship and late effects are neglected and the tag prostate-evidence.
Shares Other-cause mortality, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.
Shares USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Localised prostate cancer, intermediate risk, Screening, Localised prostate cancer, high and very high risk and the tag prostate-evidence.
Shares Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Prostate cancer and the tag prostate-evidence.
Shares USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Screening, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Prostate cancer and the tag prostate-evidence.
Shares Localised prostate cancer, intermediate risk, Screening, Localised prostate cancer, high and very high risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.
Shares Localised prostate cancer, intermediate risk, Screening, Localised prostate cancer, high and very high risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch and the tag prostate-evidence.
Shares Other-cause mortality, Localised prostate cancer, intermediate risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Prostate cancer and the tag prostate-evidence.