LA JOLLA, CA —Unlike in the general U.S. population, African American men diagnosed with prostate cancer in the VA health system do not appear to present with more advanced disease or experience worse outcomes compared with non-Hispanic white men.

That’s according to a study published in the journal Cancer which concluded that, in contrast to national trends, the VA findings suggest that access to care is an important determinant of racial equity.¹

The study from the VA San Diego Healthcare System and the University of California at San Diego noted that, overall in the United States, African American men are more than twice as likely to die of PC compared with non-Hispanic white men. The authors posited that receiving care through the VA health system, an equal-access medical system, would attenuate the disparity.

To determine that, the study team tapped into a longitudinal, centralized database of more than 20 million veterans to create a cohort of 60,035 men —18,201 AA men and 41,834 NHW men —who were diagnosed with PC between 2000 and 2015.

The two groups had some demographic differences:

• AA men were more likely to live in regions with a lower median income ($40,871 for AA men vs. $48,125 for NHW men; P < 0.001);
• AA men were also more likely to live in areas with lower high school graduation rates (83% for AA men vs. 88% for NHW men; P < 0.001).
• At the time of diagnosis, AA men were younger (median age, 63.0 years vs. 66.0 years; P < 0.001).

Results indicate that AA men had a higher prostate-specific antigen level (median, 6.7 ng/mL vs. 6.2 ng/mL; P < 0.001) but were less likely to have Gleason score 8 to 10 disease (18.8% among AA men vs. 19.7% among NHW men; P < 0.001), a clinical T classification ≥3 (2.2% vs. 2.9%; P < 0.001) or distant metastatic disease (2.7% vs. 3.1%; P = 0.01).

In fact, researchers emphasized, the 10-year PC-specific mortality rate was slightly lower for AA men (4.4% vs. 5.1%; P = 0.005), which was confirmed in multivariable competing-risk analysis (subdistribution hazard ratio, 0.85; 95% CI, 0.78-0.93; P < 0.001).

“AA men diagnosed with PC in the VA health system do not appear to present with more advanced disease or experience worse outcomes compared with NHW men, in contrast to national trends, suggesting that access to care is an important determinant of racial equity,” the authors concluded.

1. Riviere P, Luterstein E, Kumar A, et al. Survival of African American and non-Hispanic white men with prostate cancer in an equal-access health care system. Cancer. 2020;126(8):1683–1690. doi:10.1002/cncr.32666