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Understanding Racial Disparities in Prostate Cancer: A Multifaceted Approach.

Charles Cobbs1, Gregory T Chesnut1,2, Ayesha A Shafi1,3

  • 1Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

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|May 30, 2025
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Summary

African American men face higher prostate cancer (PCa) risks and mortality due to genomic, socioeconomic, and systemic factors. Equitable care and increased clinical trial participation can reduce these disparities.

Keywords:
access to healthcaregenomic studiesprostate cancerracial disparitiessocioeconomic status

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Area of Science:

  • Oncology
  • Genetics
  • Public Health

Background:

  • Prostate cancer (PCa) disproportionately impacts African American (AA) men, with higher incidence, more aggressive disease, and increased mortality compared to Caucasian American (CA) men.
  • These disparities stem from a complex interplay of genomic, socioeconomic, environmental, and systemic factors.

Purpose of the Study:

  • To review the multifactorial causes of prostate cancer disparities between AA and CA men.
  • To highlight distinct biological differences and adverse social determinants contributing to poorer outcomes in AA men.
  • To propose actionable strategies for achieving health equity in prostate cancer outcomes.

Main Methods:

  • Comprehensive literature review integrating genomic, socioeconomic, environmental, and systemic analyses.
  • Examination of molecular alterations, tumor microenvironment interactions, and social determinants of health.
  • Analysis of evidence from healthcare systems with equitable access.

Main Results:

  • AA men exhibit distinct genomic alterations (e.g., FOXA1, BRAF, CHD1 mutations) and DNA repair defects, suggesting a need for population-specific precision medicine.
  • Immune-oncologic pathways and tumor microenvironment differences contribute to aggressive disease phenotypes in AA men.
  • Adverse social determinants like limited access to care, lower screening rates, and medical mistrust exacerbate disparities, though equitable treatment can yield comparable outcomes.

Conclusions:

  • Addressing prostate cancer disparities requires a holistic approach targeting genomic, social, and systemic factors.
  • Key strategies include increasing AA representation in clinical trials, enhancing culturally competent care, improving access to early detection, and expanding community outreach.
  • Achieving health equity in prostate cancer necessitates dismantling systemic barriers and ensuring equitable treatment for all men.