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African American and white men who receive comparable treatments for prostate cancer have similar survival

Last year, we reported on two studies showing that African American men respond at least as well as white men to prostate cancer treatments given in clinical trials. Nationally, African Americans with prostate cancer are more than twice as likely to die of the disease as their white counterparts, and that has fueled speculation that genetic or biological factors put them at greater risk. But according to this new research, the survival difference disappears when men of either race get the same cutting-edge treatments.

Now scientists are reporting that African American and white men with prostate cancer live equally as long if they’re treated by the same care delivery system.

Benefits from equal access care

For this study, a team from the University of California at San Diego looked at survival data from 60,035 men who had been diagnosed and treated for prostate cancer by the US Veterans Administration (VA) Health Care System between 2000 and 2015. VA hospitals provide the same subsidized care to all eligible veterans, regardless of their socioeconomic standing. So, African American men cared for by that system don’t experience the delays in diagnosis or treatment that they can often face in the general population.

Of the men included in the study, 18,201 were African American and 41,834 were white. The African Americans tended to be diagnosed at younger ages, lived in areas with lower median incomes, and had less education and more additional health problems than the white men. Yet after adjusting for tumor grade, prostate-specific antigen levels, smoking habits, the types of treatment received, and other factors with an influence on prostate cancer survival, the investigators found that African Americans had slightly better of odds of not dying from the disease than the white men did.

Specifically, the 10-year prostate cancer-specific death rate was 4.4% among African Americans and 5.1% among white men. And among all men in the study who were still alive after 10 years, 81.8% were African Americans and 77.5% were white. According to the investigators, the results are consistent with evidence from other studies showing that racial disparities in prostate cancer survival diminish after men become eligible for Medicare or Medicaid, which also provide equal access care.

Taken together, the results suggest that high mortality from prostate cancer among African American men in the general population is driven less by genetics or biology than by delays in diagnosis and treatment, affirmed Dr. Marc Garnick, Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. Still, the study doesn’t address other mysteries, Dr. Garnick added, such as why more African American than white men develop prostate cancer, and at earlier ages. “More research into these important questions is still needed,” he said.

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