With Equal Care, African American and White Men Have Same Prostate Cancer Survival

When it comes to prostate cancer, African American men have similar survival rates to white counterparts if they have equal access to health care, a new study suggests.

Earlier research has found African Americans are twice as likely to die from prostate cancer as whites, and the reasons may include diagnosis when the disease is more advanced as well as differences in medical care.

But the new study, which followed more than 60,000 men with prostate cancer getting care from the U.S. Veterans Administration Health System, found African American men did not have more advanced disease at diagnosis and did not die earlier than white men, researchers reported in Cancer.

"Throughout the U.S. population, African Americans usually have worse outcomes with prostate cancer," said the study's senior author Dr. Brent Rose of the University of California, San Diego. "The hypothesis has been that the disease is just biologically more aggressive in African American men."

"Our study suggests that is not a foregone conclusion," Rose said. "There's something about the way the VA medical system reduces disparities seen in normal health care that suggests that equal outcomes could be created with smart policy decisions."

That doesn't mean there are no biological differences between blacks and whites when it comes to prostate cancer, Rose said. "African Americans are more likely to get prostate cancer than whites: one in eight versus one in twelve. And they tend to get it three to four years younger for reasons we have no idea about."

Nevertheless, Rose said, when African Americans get good access to care and prompt treatment, disparities in survival disappear.

Details of study

To determine whether access to health care might play a role in the disparity in survival between blacks and whites, Rose and his team analyzed information on more than 20 million veterans who receive care through the San Diego VA's health care system.

They focused on 60,035 men diagnosed with prostate cancer between 2000 and 2015, 30.3% of whom were African American and 69.7% were non-Hispanic white. Half of the men were followed for nearly six years, and some were followed for as long as 10 years.

Overall, there were 3,067 deaths from prostate cancer in the group, 848 among African American men and 2,219 in non-Hispanic white men.

Contrary to the situation in the general population, African American men in the VA were not diagnosed with later-stage cancer than their white counterparts, although they did get diagnosed at a younger average age: 63 versus 66 years old.

The rate of prostate cancer death over a 10-year span among black men was slightly lower than the rate among whites: 4.4% versus 5.1%.

Issue of diagnosis

The new results are very good news, said Dr. Ashutosh Tewari, chairman of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. "When you find the cancer at the same stage, you can have the same survival outcome," Tewari said. "This is important news."

Nevertheless, it doesn't solve the problem in the general population, Tewari said. "Many more African Americans are still dying from prostate cancer," he said.

Researchers need to find a way to diagnose prostate cancer earlier in African American men in the general population, Tewari said.