Black men face grim prostate cancer realities with surgery

In a study published recently in Cancer, the journal of the American Cancer Society, UW Medicine investigators found that Black men are more likely to receive care from providers and facilities with low surgical volumes — a surrogate measure for lower surgical quality in the study — and were less likely to be treated at a larger cancer center. This may contribute to the fact that Black men have an almost twofold higher risk of dying from prostate cancer compared to their peers, study authors noted.

“We had a hypothesis that structural factors such systemic racism likely led Black men to access lower quality surgical care and that this might be a contributing factor” to the higher death rate experienced by Black men, said Dr. Yaw Nyame, a UW Medicine urologist and lead author of the study.  Nyame’s team, formed in 2020, has been looking at why Black men die of prostate cancer at greater rates than other ethnicities.

Perhaps most concerning, study authors noted, is that death rates for Black men treated by surgeons and facilities performing fewer surgeries had a 61% higher risk of dying from prostate cancer over median follow-up of 71 months. This difference in prostate cancer death likely reflects scarcity of resources and less extensive experience in managing prostate cancer among the surgeons and facilities from whom Black men received care, the study showed. 

The study found that Black men were younger at the diagnosis of their prostate cancer, had longer time delays to surgery, higher PSAs at diagnosis, more comorbid conditions, and lived in areas with lower socioeconomic status compared to their peers. In general, the report noted, Black men receive lower quality prostate cancer surgery in the United State when using surgeons and facilities with lower volumes of prostate removal surgery.

The study focused on surgeon experience because that has been a well-established surrogate for quality, as it correlates with complications after surgery and survival, study authors noted.  But higher quality surgical care is not just a reflection of an individual surgeon, but "it is reflective of the entire team and institution,” Nyame said.  “It is the operating team, clinic and support staff, and often, the graduate trainees, that all contribute to experience, skills, and assets that a surgeon or facility has to support higher volumes of surgery.” 

Nyame intends to bring this information to the Black and African Descent Collaborative for Prostate Cancer Action leadership team to evaluate opportunities to study how to improve access to and the utilization of higher quality care among Black prostate cancer patients. He anticipates this will result in qualitative analyses that are informed by these results. The team did qualitative interviews with Black men around prostate cancer screening over the summer and fall of 2022.

The UW Medicine group who looked into the statistics expected to find this outcome, but what was a bit of a surprise is how quickly the narrative changed if Black men went to a hospital where the surgery volumes where high. Those Black men survived at the same rates as non-Black men, Nyame noted.

The UW Medicine led study evaluated Surveillance, Epidemiology, and End Results (SEER) cancer registry data and Medicare claims from 31,478 men between 2005 to 2015. Black men represented 6.7% (or 2,123) of the population group.

“Combining these study results with qualitative research help us find and understand where the pressure points lie,” Nyame said. “And where there is more opportunity to create more equity to improve the quality prostate cancer care among Black men.”

In 2022, Nyame and Dr. John Gore published a conceptual model and literature review that showed how structural determinant of equity (such as systemic racism, economic systems, and laws or policies), social determinants of health, and health factors intersect to drive racial inequities in prostate cancer care and outcomes  Using this framework, Nyame — then a urologic oncology fellow at UW Medicine under Gore's mentorship —chose to evaluate the effects that treatment quality plays in worse prostate cancer.  This is one of several studies which came out of that collaboration.

This work was supported by funding from the Department of Defense (CDMRP W81XWH1910577) and the National Cancer Institute of Specialized Programs of Research Excellence (P50CA097186-17).

Written by Barbara Clements - 253-740-5043, bac60@uw.edu

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