Striving for Equity: Examining Health Disparities in Urologic Oncology

Health disparities are not new, but in urologic oncology, they remain persistent, impactful, and too often overlooked. In our review, we set out to examine disparities across the most common urologic cancers—prostate, bladder, kidney, and testicular cancer—through the lenses of race, socioeconomic status, geography, gender identity, and insurance access. What we found underscores a pressing need for change across every level of cancer care delivery.

Persistent Gaps, Despite Advancements

While advances like robotic surgery, targeted therapies, and improved diagnostics have transformed outcomes for many, they’ve also widened the gap between those with access and those without. For example, Black men are more likely to present with advanced prostate cancer, and women with hematuria experience delays in urologic evaluation compared to men. LGBTQIA patients continue to face challenges with screening, and language barriers remain a critical issue for Latinx communities. These disparities are not incidental—they are systemic.

A Multilayered Problem

The disparities we highlighted stem from complex interactions between social determinants of health and systemic barriers. From low health literacy and delayed diagnoses to unequal insurance coverage and lack of culturally competent care, each factor contributes to poorer outcomes. We found that patients from lower-income backgrounds were less likely to receive timely surgery or participate in clinical trials, further perpetuating inequity. Geographic barriers and neighborhood deprivation indices (e.g., ADI) only exacerbate this.

Redesigning the System

Solutions exist—but they require coordinated action. We advocate for expanded access to advanced treatments, greater investment in disparity-focused research, and restructuring how care is delivered. Programs like Minority Men’s Health Center and IMPACT are promising blueprints, but broader implementation is needed. We also stress the importance of integrating disparity education into medical training, improving trust through patient-centered outreach, and prioritizing diversity in clinical trials and the healthcare workforce.

Looking Ahead

The future of urologic oncology should not be defined by zip code, income bracket, or skin color. Precision medicine, AI, and novel therapies are exciting, but unless they are paired with policies that promote equity, they risk reinforcing the very disparities we aim to eliminate. Health equity isn’t a trend—it’s a mandate. And addressing disparities is no longer optional. It’s the key to improving cancer outcomes for all.

Written by: Dhruv Puri, Department of Urology, UC San Diego School of Medicine, La Jolla, CA

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