Prostate Cancer Risk Assessment: Addressing Racial Equity Concerns "Discussion"
July 24, 2024
At the CAncer or Not Cancer: Evaluating and Reconsidering GG1 prostate cancer (CANCER-GG1?) Symposium, experts debate the disparities in prostate cancer outcomes among different racial groups, particularly focusing on African American men. They challenge previous findings, noting that several studies have failed to replicate significant differences in progression rates when access to care is equalized. The discussion concludes by emphasizing the importance of diverse population enrollment in studies to better understand potential biological differences and their impact on treatment responses, drawing parallels with similar issues in breast cancer research.
Related Content:
Racial Disparities in Prostate Cancer Active Surveillance Outcomes "Presentation" - Quoc-Dien Trinh
AUA 2022: Racial Disparities in Rates of Gleason Grade Reclassification in a Multi-Institutional Prostate Cancer Active Surveillance Cohort: A Pennsylvania Urology Regional Collaborative (PURC) Analysis
Racial Disparities in Prostate Cancer Active Surveillance Outcomes "Presentation" - Quoc-Dien Trinh
AUA 2022: Racial Disparities in Rates of Gleason Grade Reclassification in a Multi-Institutional Prostate Cancer Active Surveillance Cohort: A Pennsylvania Urology Regional Collaborative (PURC) Analysis
Read the Full Video Transcript
Speaker 1: It's terrific talking to both of you. But just for conversation's sake, Quoc, for instance, I agree with everything you said based on the studies you showed. Except what you didn't show is that in that Hopkins paper, there were seven institutions afterwards that tried replicating it, and they didn't see any difference between men of African ancestry or not. There are multiple surveillance series galore, there's a half a dozen of them that with appropriate access, there's no difference in progression rates. There's the desk paper that looked at all sorts of clinical trials in the VA and elsewhere.
So, I think there's more of a picture than just what you're saying. And I agree with you on the Decipher stuff, but that slide, it's 2 African-American men that were high risk, 2 of the 11.
Speaker 2: Yeah, so that's the point I'm trying to make here is that it's actually only 20%. Because if you look at it for risk factors, I don't want to go there but look at it. It's 20 and almost 40%. So it's the low and favorables that we treat the same that is collectively about 20% in that group. So it's consistently in that proportion-
Speaker 1: Got it.
Speaker 2: ... where you start increasing the numbers that we're discussing. But to your point, this is why in the initial slides I wanted to separate the general population from near equal access. Because you're right, in the near equal access environment, you don't see those up rates that I've seen. It's all a numbers issue. More in, more out, that's it. But when you add in the other populations, that have access issues, then you start to see those increased upgrading upstages..
Speaker 3: Sorry. Just on this slide before we move slides. It's worth emphasizing again just how few, it's less than 10% of the patients in the cohort groups, are low risk. We are wiping out low risk disease anyway with MRM biomarkers-
Speaker 2: That's right.
Speaker 3: ... and Gleason regrading. So I'd say again, the low risk cancer is becoming an accidental diagnosis. There's no reason for these patients to carry it. Sorry, go ahead.
Speaker 1: No, I was just going to make the point. I agree with you and I think that in the three-minute presentation I wanted more of the alarmists about the situation and mostly the facts are that there is a difference. Maybe this difference has more to do with access to care, access to high-quality diagnostics, but if we don't corner this correctly and it leads to something terrible from a public health standpoint, it's not going to be a great look.
Speaker 3: We share that concern. Yes, I agree with you.
Speaker 2: All right.
Speaker 4: We can come up with additional criteria that's when you're screening, you're looking at risk. There are big studies in Stockholm we're doing something similar across the country and the important part is to make sure that your enrollment of diverse populations is high so that you can actually ask those questions and you can ask questions. Again, very similar, breast and prostate cancer and hormone-positive group for African-American women who do not respond well with hormone therapy or chemo and they have twice the mortality rate. So that's the same biology just in prostate cancer. We need to be looking at these kinds of things because likely to become-
Speaker 1: It's terrific talking to both of you. But just for conversation's sake, Quoc, for instance, I agree with everything you said based on the studies you showed. Except what you didn't show is that in that Hopkins paper, there were seven institutions afterwards that tried replicating it, and they didn't see any difference between men of African ancestry or not. There are multiple surveillance series galore, there's a half a dozen of them that with appropriate access, there's no difference in progression rates. There's the desk paper that looked at all sorts of clinical trials in the VA and elsewhere.
So, I think there's more of a picture than just what you're saying. And I agree with you on the Decipher stuff, but that slide, it's 2 African-American men that were high risk, 2 of the 11.
Speaker 2: Yeah, so that's the point I'm trying to make here is that it's actually only 20%. Because if you look at it for risk factors, I don't want to go there but look at it. It's 20 and almost 40%. So it's the low and favorables that we treat the same that is collectively about 20% in that group. So it's consistently in that proportion-
Speaker 1: Got it.
Speaker 2: ... where you start increasing the numbers that we're discussing. But to your point, this is why in the initial slides I wanted to separate the general population from near equal access. Because you're right, in the near equal access environment, you don't see those up rates that I've seen. It's all a numbers issue. More in, more out, that's it. But when you add in the other populations, that have access issues, then you start to see those increased upgrading upstages..
Speaker 3: Sorry. Just on this slide before we move slides. It's worth emphasizing again just how few, it's less than 10% of the patients in the cohort groups, are low risk. We are wiping out low risk disease anyway with MRM biomarkers-
Speaker 2: That's right.
Speaker 3: ... and Gleason regrading. So I'd say again, the low risk cancer is becoming an accidental diagnosis. There's no reason for these patients to carry it. Sorry, go ahead.
Speaker 1: No, I was just going to make the point. I agree with you and I think that in the three-minute presentation I wanted more of the alarmists about the situation and mostly the facts are that there is a difference. Maybe this difference has more to do with access to care, access to high-quality diagnostics, but if we don't corner this correctly and it leads to something terrible from a public health standpoint, it's not going to be a great look.
Speaker 3: We share that concern. Yes, I agree with you.
Speaker 2: All right.
Speaker 4: We can come up with additional criteria that's when you're screening, you're looking at risk. There are big studies in Stockholm we're doing something similar across the country and the important part is to make sure that your enrollment of diverse populations is high so that you can actually ask those questions and you can ask questions. Again, very similar, breast and prostate cancer and hormone-positive group for African-American women who do not respond well with hormone therapy or chemo and they have twice the mortality rate. So that's the same biology just in prostate cancer. We need to be looking at these kinds of things because likely to become-