To provide commentary on the disparities in access to clinical trials and precision oncology specific to Black men with Prostate Cancer (PCa) in the United States and lend a general framework to aid in closing these gaps.
The ideas, commentaries and data presented in this narrative review were synthesized by utilizing qualitative and quantitative studies, reviews, and randomized control trials performed between 2010 and 2021. We searched PubMed using the key words "Medicaid", "Medicare", "clinical trials", "African Americans", "Black", "underrepresentation", "access", "Prostate Cancer", "minority recruitment", "racial disparities", "disparity", "genomics", "biomarkers", "diagnostic" "prognostic", "validation", "precision medicine", and "precision oncology" to identify important themes, trends and data described in the current review. Keywords were used alone and combination with both "AND" and "OR" terms.
Black men with prostate cancer (PCa) in the United States have earlier onset of disease, present with more advanced stages, and worse prostate cancer-specific survival than their White counterparts. Potential causative factors vary from disparities in health care access to differences in tumor immunobiology and genomics along with disparate screening rates, management patterns and underrepresentation in clinical and translational research such as clinical trials and precision oncology.
To avoid increasing the racial disparity in PCa outcomes for Black men, we must increase inclusion of Black men into precision oncology and clinical trials, using multilevel change. Underrepresentation in clinical and translational research may potentiate poorly validated risk calculators and biomarkers, leading to poor treatment decisions in high-risk populations. Relevant actions include funding to include minority-serving institutions as recruitment sites, and inclusion of evidence based recruitment methods in funded research to increase Black representation in clinical trials and translational research.
Urology. 2021 Sep 25 [Epub ahead of print]
Ashanda R Esdaille, Christine Ibilibor, Arturo Holmes Ii, Nynikka R Palmer, Adam B Murphy
Department of Urology, University of Wisconsin at Madison School of Medicine and Public Health, 1685 Highland Avenue, 3257 MFCB, Madison, WI 53704, USA. Electronic address: ., Department of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229., Department of Urology, SUNY Downstate Medical Center, 471 Clarkson Avenue, Brooklyn, NY 11230, USA., Department of Medicine, Urology and Radiation Oncology, University of California San Francisco, San Francisco General Hospital, 1001 Potrero Ave, UCSF Box 1364, San Francisco, CA 94143, USA., Department of Urology, Northwestern University Feinberg School of Medicine, Tarry Building Room 16-729, 303 E. Chicago Avenue, Chicago, IL 60611, USA.