ABSTRACT
Objective
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.
Materials and Methods
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.
Results
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.
Conclusion
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.
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Article info
Publication history
Published online: September 25, 2021
Accepted:
September 14,
2021
Received:
May 4,
2021
Footnotes
Conflict of Interest: The authors declare no conflict of interest.
Financial Disclosure: Dr. Adam Murphy serves as a paid advisor for EpiScore and Oncotype Dx Prostate Cancer Assays; Dr. Nynikka Palmer is funded by the National Cancer Institute of the National Institutes of Health, grant # K01CA211965.
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