Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
Oncologist. 2021 Jul;26(7):537-548. doi: 10.1002/onco.13749. Epub 2021 Mar 22.
Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exist among Black men in this country. The primary objective of this systematic review is to describe the reported disparities in screening, diagnostics, and treatments as well as efforts to alleviate these disparities through community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, subanalyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal-access care environments have shown similar outcomes regardless of race. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials, and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. IMPLICATIONS FOR PRACTICE: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher prostate-specific antigen, and other adverse factors, but outcomes can be attenuated in trials or in equal-access care environments. Recent data have shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts, and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities.
前列腺癌仍然是美国男性中被诊断出的主要癌症和第二大致死原因。尽管在筛查方式、诊断和治疗方面有所改进，但该国黑人男性之间仍存在差异。本系统评价的主要目的是描述在筛查、诊断和治疗方面报告的差异，以及通过社区和教育外展努力来减轻这些差异的努力。对 PubMed 数据库中英语出版物的回顾性、前瞻性和社会描述性数据进行了批判性审查。尽管黑人男性的表现更为先进，筛查和诊断程序的比例较低，试验纳入率较低，但亚分析表明，各种治疗模式在黑人人群中都非常有效。此外，无论种族如何，在前瞻性临床试验中接受治疗并在平等获得护理环境中接受治疗的患者都表现出相似的结果。开展更多的前瞻性研究，并加强参与筛查、诊断和基因检测、临床试验以及基于社区的教育工作，对于确保所有患者在前列腺癌方面取得平等进展非常重要。
临床意义：在前列腺癌的治疗进展方面取得了显著进展，但种族差异仍然存在。筛查率的差异和诊断程序的实用性在这些差异中起着作用。黑人患者通常表现出更晚期的疾病、更高的前列腺特异性抗原和其他不利因素，但在试验或平等获得护理环境中，结果可以减轻。最近的数据表明，多种治疗模式在黑人人群中非常有效。增加临床试验参与、加强分散试验努力以及实施成功的患者导航和社区伙伴关系模式的新的大胆假设对于确保前列腺癌差异方面的持续进展至关重要。
