How Social Determinants of Health Align with Disparities in Prostate Cancer Diagnosis and Treatment

Prostate cancer is the second leading cause of cancer-related death and the most common cancer diagnosis for men in the U.S. The incidence of prostate cancer among African American males is approximately 70% higher than Caucasian males, but a particular treatment is helping increase survival rates in some patients. 

Patients with metastatic castrate-resistant prostate cancer (mCRPC) treated with Ra-223 experience prolonged overall survival, particularly African Americans compared to Caucasians, said medical student Johnny Yang who presented his findings on Tuesday.

Yang is a student at the University of Mississippi Medical Center in Jackson and said the issue of health disparities is personal to him. 

“Growing up in rural Mississippi and living through poverty as a child of immigrants, I understand deeply the social challenges to health care. Mississippi ranks last in a variety of health metrics,” he said. “African Americans, the primary minority group, significantly experience worse outcomes for prostate cancer and challenges in accessing treatment. Thus, I want to better understand and research prostate cancer from a unique lens.”

Study Looked At Treatment Outcomes and Social Determinants

Radium-223 dichloride (Ra-223) is indicated in castrate-resistant prostate cancer with bone metastases and no visceral metastases. 

Yang conducted a retrospective review for mCRPC patients diagnosed and treated with Ra-
223 at an academic medical center to elucidate patient characteristics, staging, imaging characteristics and social determinants of health (SDOH) variables that may affect patient outcomes. These included race, the average income of the city of residence, health care access and distances traveled for treatments.

After treatment with Ra-223, an overall median survival time of 14 months and 11 months was observed for African Americans and Caucasians. The study found that 66.7% of African Americans and 50% of Caucasians traveled greater than 50 miles for treatments.

This study reports improved survival in African Americans compared to Caucasians with mCRPC treated with Ra-223. 

Since African Americans in the study faced more significant SDOH, this paradoxical observation may suggest a protective factor for African Americans likely secondary to biological genetic factors. The study’s primary limitations are a small cohort size and limited specificity of SDOH, which warrant further investigation.

Though lacking in statistical support due to a limited cohort size, the team observed a similar paradoxical finding reported in a large cohort study of National Cancer Database patients, Yang noted.  

In that database, African Americans experienced more positive outcomes after receiving Ra-223 for metastatic castrate-resistant prostate cancer when compared to Caucasians, even though they may experience more health care barriers. 

“First, awareness is crucial. We hope that radiologists, particularly those diagnosing and treating patients with prostate cancer, know that this paradoxical observation exists,” Yang said. “Second, we want radiologists to further improve on our study's limitations. Third, the paradoxical finding should serve as a clue and motivation for further investigation of precision medicine efforts for metastatic castrate-resistant prostate cancer and beyond.”

Access the poster, “An Initial Observational Study on Surprising Favorable Healthcare Disparities with Radium 223 Therapy,” (T5B-SPNMMI-1) on demand at RSNA.org/MeetingCentral