• Posted December 27, 2022

U.S. Men's Race, Residence Could Raise Odds for Fatal Prostate Cancer

The color of his skin and where he lives may influence an American man's odds of dying from prostate cancer, a new study reveals.

Black men and men living in the Western United States face the most dire prognosis, American Cancer Society (ACS) researchers report.

"Why prostate cancer mortality is so high in the Western region, including California, despite lower incidence rates overall -- we actually don't understand what that is," said ACS CEO and study co-author Karen Knudsen.

Moreover, why Black men with prostate cancer fare less well than white men also isn't clear.

"Only about 33% of men that are eligible for prostate cancer screening get screened, and it's approximately the same between Black men and white men," Knudsen said. "So, that can't be the underlying cause of this higher incidence of being diagnosed with prostate cancer, but they have a 111% higher death rate."

Part of this disparity might be due to fewer Black men being included in clinical trials, she said. That results in a poorer understanding of genetic and other factors that might affect their odds of getting prostate cancer.
Other factors include a lack of health insurance and access to care and screening that continues to plague the Black community, Knudsen said.

"Right now, 2022 estimates are that we will see more than 268,000 men diagnosed with prostate cancer, and unfortunately, more than 34,000 will lose their life to prostate cancer. And we know that we have effective strategies for treating early-stage disease," she said.

Her team's report was published Dec. 21 in the journal European Urology.

Dr. Anthony D'Amico, chief of the Division of Genitourinary Radiation Oncology at the Dana-Farber Cancer Institute in Boston, isn't surprised at the increase in late-stage prostate cancer diagnoses and resulting deaths.

"Advanced-stage prostate cancer coincides with the time period approximately eight years or so after the recommendation by the U.S. Preventive Task Force in 2012 to not screen," he said. "If you stopped screening in 2012, by 2017 or '18, you'd expect to see more metastatic [spreading] disease. And by 2020 or '21, you expect to see an increase in death."

That recommendation has been reversed, as it's clear that screening for prostate cancer saves lives, D'Amico noted.

"Now we should start to reverse these trends, and get back to where it was," he added.

D'Amico, who was not part of the study, thinks that when it comes to prostate cancer, the disparity between Black and white men is largely due to not being screened and not having access to care.

It's not only prostate cancer that shows a disparity in survival. It persists for all genitourinary cancers, including bladder, kidney and testicular cancers, the researchers found.

For the study, Knudsen and her colleagues used data from the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results Database and death rates from the U.S. Center for Disease Control and Prevention.
The researchers found that the highest rates for bladder cancer were among white men and women living in the Northeast.

The increase in bladder cancer rates in the Northeast may be due to increased levels of arsenic in well water in that area, Knudsen said.

The highest rates of kidney cancer were among white men and women living in Appalachia and some areas in the South. The high rates of kidney cancer in these areas may reflect an increase in obesity and smoking, she said.

For bladder and kidney cancer, a gender disparity also exists, Knudsen said. Men with bladder or kidney cancer are two to four times more likely to die from these cancers than women, she said.

Rates of testicular cancer increased in all racial and ethnic groups, but death rates increased only among Hispanic men.

"This is something that was really unexpected," Knudsen said. "It's on the rise for both incidence and mortality, and we have no understanding of the underlying basis for that observation for any demographic," she said.

Knudsen said that the bottom line is understanding how you can reduce your own risk for each of these cancers.

"We know that maintaining a healthy weight and not smoking are major major benefits in cancer prevention. As for prostate cancer, it's understanding your own risk. When it comes to testicular cancer, understand that this is a cancer of primarily younger adults that's on the rise, and if something seems amiss consult your primary care physician," she said.

"If I could wave a magic wand, I would ask every individual when they go into the physician's office, irrespective of the reason, to ask, what is the right cancer screening plan for me?" Knudsen said.

More information
For more on prostate cancer, see the American Cancer Society.

SOURCES: Karen Knudsen, MBA, PhD, chief executive officer, American Cancer Society; Anthony D'Amico, MD, PhD, chief, Division of Genitourinary Radiation Oncology, Dana-Farber Cancer Institute, Boston; European Urology, Dec. 21, 2022