Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes.
To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions.
A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes.
Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men.
Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes.
Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
European urology. 2022 Mar 30 [Epub ahead of print]
Yaw A Nyame, Matthew R Cooperberg, Marcus G Cumberbatch, Scott E Eggener, Ruth Etzioni, Scarlett L Gomez, Christopher Haiman, Franklin Huang, Cheryl T Lee, Mark S Litwin, Georgios Lyratzopoulos, James L Mohler, Adam B Murphy, Curtis Pettaway, Isaac J Powell, Peter Sasieni, Edward M Schaeffer, Shahrokh F Shariat, John L Gore
Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Electronic address: ., Department of Urology, University of California at San Francisco, San Francisco, CA, USA., Department of Urology, University of Sheffield, Sheffield, UK., Department of Urology, University of Chicago, Chicago, IL, USA., Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA., Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA., Department of Medicine, University of California San Francisco, San Francisco, CA, USA., Department of Urology, The Ohio State University, Columbus, OH, USA., Department of Urology, University of California Los Angeles, Los Angeles, CA, USA., Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK., Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA., Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA., Department of Urology, Wayne State University, Detroit, MI, USA., Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA., Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.