Bridging the gap: Mitigating disparities in prostate cancer outcomes

While overall cancer survival rates have increased over the past several decades, the widespread impact of progress in cancer research and treatment is hampered by persistent disparities in time to diagnosis, access to care, and health outcomes. This sobering fact is particularly evident in prostate cancer. 

The disease is the second most common cancer diagnosis and cause of cancer death in men, accounting for 29% of new cancer diagnoses each year, but mortality rates vary substantially by race and socioeconomic status. A complex interplay of biological, environmental, and social factors drives these disparities, making it anything but simple to develop solutions. However, improving patient access to simple, efficient, and specific screening methods is a foundational step in bridging the gaps in prostate cancer outcomes. 

Notable disparities in prostate cancer incidence & outcomes

Racial differences in prostate cancer represent the largest cancer health disparity in the United States. Despite a lower incidence of cancer overall, prostate cancer mortality rates among Black men are roughly double that of all other races. Black men diagnosed with prostate cancer also tend to be younger and are more likely to have more advanced cancer at the time of initial biopsy. These disparities are influenced by a complex interplay of social, environmental, and biological variables. Evidence suggests that biological factors, such as epigenetic alterations and comorbidities, may play a role in driving racial disparities in prostate cancer. However, because Black men are underrepresented in prostate cancer clinical trials relative to their disease incidence, clinical research may fail to capture key data on differential health outcomes in the population.

Socioeconomic status (SES) and other social determinants of health are also significant sources of disparity in prostate cancer diagnosis and treatment. While prostate cancer diagnosis rates are positively associated with socioeconomic status, lower SES tends to correlate with worse outcomes. Men with lower SES tend to be diagnosed at later stages of the disease, are more likely to have metastases at the time of diagnosis, and have decreased survival rates. Overcoming these disparities requires a multifaceted approach that includes increasing awareness and education about prostate cancer risk, addressing social determinants of health, and, perhaps most critically, making screening and treatment more accessible and affordable for all patients. 


Challenges and limitations in prostate cancer screening

The timing of prostate cancer diagnosis can have a significant impact on patient outcomes. Cancers detected in early stages may be addressed with less invasive treatment approaches and are often associated with improved survival rates; prostate cancer detected prior to metastasis has a five-year survival rate of nearly 100%. Racial and socioeconomic disparities are evident in the timing of diagnosis, as both Black men and men from lower socioeconomic backgrounds are more likely to be diagnosed with advanced disease. 

Early cancer detection requires effective, accessible, and actionable screening approaches. The prostate-specific antigen (PSA) test is the current standard for prostate cancer screening. Elevated levels of PSA in the blood are indicative of prostate disease, warranting follow-up testing, such as a biopsy, to establish a cancer diagnosis. However, the PSA test is not a perfect cancer screening tool. Because an elevated PSA result can be caused by non-cancerous conditions, such as an enlarged prostate, prostatitis, or even riding a bicycle, high PSA can essentially be a false positive that results in further unnecessary testing. Men with an elevated PSA level have a roughly 1 in 4 chance of having prostate cancer, but not all cases constitute high-grade disease that warrants intervention. 

The limitations of PSA testing are further exacerbated by the discomfort and risk associated with prostate biopsy. In addition to being stressful and unpleasant for most patients, the procedure can result in infection and even life-threatening sepsis. When screening methods fail to yield clear results and leave patients to face unnecessary follow-up testing, there is little incentive to actively pursue screening. This only widens the disparities in timely prostate cancer diagnosis associated with distrust, embarrassment, financial strain, and limited access to healthcare. 

Overcoming disparities with accessible & accurate screening methods

While public health research provides clear evidence of the need for increased education and communication in communities disproportionately affected by prostate cancer, overcoming disparities in disease burden will require concrete steps to increase access to timely diagnosis and treatment. Reimagining our approach to prostate cancer screening is a key first step. According to new guidelines published by the Prostate Cancer Foundation, Black men are now encouraged to consider baseline PSA testing between the ages of 40 and 45, rather than the established recommendation of ages 55 to 69, followed by screening at regular intervals until age 70. However, if current methods are inconclusive, requiring inconvenient, unpleasant, and often unnecessary follow-up testing to yield actionable results, is it realistic to expect patients to assume the personal and financial burden of regular screening? 

Mitigating prostate cancer disparities through earlier detection will require affordable and accurate testing that provides specific, actionable results and is easy to implement in virtually any community healthcare setting. Novel diagnostic technologies have largely shifted to a focus on biomarkers at the level of the genome or transcriptome, but the data gleaned from these approaches represents molecular instructions that may not directly translate into protein- or disease-relevant alterations. While their insights can be valuable for guiding the selection of molecularly targeted therapies, the relatively high cost and complex interpretation of RNA- and DNA-focused diagnostics limits their applicability as screening tools. 

Alternatively, by turning to simpler, more cost-effective methods that emphasise efficiency and accuracy, we can create screening tools that overcome the limitations of PSA testing while broadening patient access. Innovative approaches, such as tools that assess alterations in PSA structure, rather than concentration, can help identify patients at greatest risk for prostate cancer without requiring specialised equipment or advanced interpretation. More specific insights can, in turn, reduce the number of unnecessary biopsies and mitigate the stress and costs associated with excessive diagnostic procedures.

Pursuing improved prostate cancer outcomes for all patients

Decades of research have built a deeper understanding of cancer than ever before, enabling scientists and clinicians to identify valuable biomarkers, develop targeted therapies, and improve outcomes. Despite this progress, significant disparities remain in prostate cancer incidence and outcomes across race and socioeconomic status. While completely overcoming inequities in diagnosis and care will require significant social and financial investment, creating accessible, accurate, and patient-friendly methods for early prostate cancer screening will be a foundational contribution in closing these gaps.

About the author

Dr Arnon Chait is the chief executive officer of Cleveland Diagnostics. An entrepreneur, scientist, and educator, Dr Chait’s extensive multidisciplinary background spans physics, engineering, and bioscience. As CEO, he applies his vast experience commercialising innovative science to drive Cleveland Diagnostics’ vision of bringing early cancer detection into everyday practice with advanced testing that is more simple, accurate, and cost-effective than current options.

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