Equal Access Health Care May Improve Survival Outcomes Among Men with Prostate Cancer

Despite national trends suggesting otherwise, a recent study found that African American men in the Veteran Affairs (VA) health system did not present with more advanced prostate cancer or experience worse outcomes, compared with their non-Hispanic white counterparts.

“African American men in the general US population are more than twice as likely to die of prostate cancer as non-Hispanic white men due to both increased incidence and poorer survival after diagnosis,” the researchers wrote. “Epidemiological evidence has suggested that genetic and/or biologic factors may be an important component of the increased incidence and younger age at diagnosis noted among (African American) men, but there are numerous studies demonstrating differences in patterns of care and socioeconomic factors that may contribute to the remarkable difference in prostate cancer—specific mortality between (African American) and (non-Hispanic White) men.”

However, they added, the racial gap in cancer mortality declines after the age of 65 — when individuals are covered under Medicare.

Therefore, the researchers evaluated differences among African American men and non-Hispanic white men using the VA health system, “an equal-access system for qualifying members that treats a large, diverse, male population of all adult ages.” They aimed to determine the differences in prostate cancer survival outcomes in 60,035 men, including 18,201 African American men (30.3%) and 41,834 non-Hispanic white men (69.7%) who were diagnosed with prostate cancer between 2000 and 2015.

The median follow-up was 5.79 years for African American men and 5.89 years in non-Hispanic white men.

The researchers found that African American men, compared with non-Hispanic white men, were more likely to live in regions with a lower median income ($40,871 versus $48,125, respectively) and lower high school graduation rates (83% versus 88%). African American men also had a higher rate of military service-related disability (41.5% versus 34.8%) and a higher burden of medical comorbidities (14.4% versus 12.5%).

At the time of diagnosis, they were also younger (median age, 63 years versus 66 years) and had a higher prostate-specific antigen level (median PSA, 6.7 ng/mL versus 6.2 ng/mL). However, African American men were less likely to have a Gleason score (used to help evaluate the prognosis of men with prostate cancer using samples from a prostate biopsy) of 8-10 disease (18.8% versus 19.7%), a clinical T classification (the size of the original tumor) 3 or less (2.2% vs 2.9%) or distant metastatic disease (2.7% vs 3.1%).

Lastly, African American men had a slightly lower 10-year prostate cancer-specific mortality rate, compared with non-Hispanic white men (4.4% vs 5.1%.

First, (African American) men were not found to be more likely to experience delays in diagnosis and care. Second, (African American) men were not found to be more likely to present with higher grade or metastatic disease. Finally, (African American) men with (prostate cancer) were not more likely to die of their disease. In fact, there was a very small, but statistically significant, decrease in the rate of death from (prostate cancer),” the researchers wrote. “… the results herein have suggested that access to high-quality medical care is a major determinant of racial equity among men diagnosed with (prostate cancer).”

The researchers highlighted the fact that equal-access health care coverage played an important role in their findings. However, it is still unclear if improved prostate cancer-specific mortality was improved because of access to care or more aggressive screening, treatment and follow-up.

“In the coming years, studies should continue to track longitudinal patterns in (prostate cancer-specific mortality) to identify systems-level changes to address racial disparities, especially as VA care begins to involve more private sector alternatives with programs such as the Veterans Choice Program, as the long-term effects of Medicaid expansion on (prostate cancer) outcomes begin to manifest, and as (prostate cancer) screening guidelines continue to evolve.”