When it comes to prostate cancer, Black communities continue to carry a heavy burden.
In the U.S., one in in six Black men will develop the disease in his lifetime (versus one in eight white men). What’s more, Black patients are two to four times more likely to die from prostate cancer than people from any other racial or ethnic group.
Many factors interact to produce these stark disparities, said Samuel L. Washington III, MD, MAS, an assistant professor of urology at University of California, San Francisco. While Black people are more likely to carry certain inherited gene changes linked to prostate cancer, factors specific to providers, healthcare systems, and geographic regions also play a role—and many can be overcome using innovative, community-based research and solutions, he said.
To support this work, PCF in 2024 granted Dr. Washington a Young Investigator Award—a $225,000 grant covering three years of work by an early-career scientist whose research promises to significantly improve clinical care for patients with prostate cancer.
The award has led to a unique approach in which clinicians, healthcare leaders, and community organizations work together to identify local barriers to prostate cancer care and tailor interventions to overcome them, Dr. Washington said. “This work has not been done before. It can serve as a framework for other healthcare systems efforts nationally.”
Root causes
Decades of research show that Black communities experience significantly higher rates of prostate cancer, more aggressive disease, and worse survivorship than whites and people of other races and ethnicities. “We have known that these disparities are persistent, and they are not just about biology,” Dr. Washington said. “It’s the interaction between biology, the environment in which people live, work, and play, and their experiences on their cancer journey.”
For example, Black people in the U.S. are more likely to live in neighborhoods with high levels of poverty and worse schools, jobs, and housing. These factors fuel chronic stress, which affects genetic pathways in the body specifically linked to aggressive prostate cancer.
Black patients also are more likely than white patients to face delays in prostate cancer diagnosis, to wait longer to start treatment, and to receive inadequate care. These disparities affect “every point along the prostate cancer care journey” and are worsened by barriers like under-insurance, transportation problems, and food and housing insecurity, Dr. Washington said.
Strikingly, when such barriers are removed or reduced, prostate cancer treatment outcomes are nearly the same in Black patients as in whites. “It is a powerful finding that in the VA [the Veterans Administration, which provides healthcare to veterans without the need for private health insurance], Black patients with prostate cancer have the same or better outcomes as other VA patients with the disease,” Dr. Washington said. “This shows that care implementation is a key aspect of improving outcomes, that it should not be overlooked.”
Righting historical wrongs
Historically, some medical professionals and systems have greatly harmed Black people—such as by denying them access to essential medications during research studies or clinical visits. These profound ethical violations span decades and have caused great trauma and distrust of healthcare providers within some communities of color.
Some of these problems persist today—recent research suggests that Black patients with prostate cancer are less likely than white patients to report good doctor-patient communication or to perceive that they had received high-quality care.
Repairing historical harms is challenging, but trying to do so is crucial to improve disparities, Dr. Washington said. “For clinicians, the starting point is to ask questions. Not all community providers have data on these issues, but they could ask and start to look. Ask, ‘What is my role here? What information can I collect that might help change this, at least within my clinical sphere of influence?’”
Likewise, researchers should describe disparities in ways that inform the design and testing of programs to overcome them, Dr. Washington said. “This is an area where conventional healthcare research has fallen short. We have done a good job figuring out that disparities exist. What we have lacked is research showing how to create programs that make a long-lasting difference.”
A new approach
With support from PCF, Dr. Washington and his colleagues are partnering with underserved San Francisco communities to learn how to improve prostate cancer care. In a novel approach, they are directly asking patients and community leaders what they need to improve diagnosis and treatment of the disease, and how best to help.
“We are trying to understand barriers to care at a systems level and within our geographic region,” Dr. Washington said. “But we also need to understand problems as communities see them, and how they are addressing them. As researchers or clinicians, are the solutions that we design what communities need, want, and would use?”
The researchers also will directly compare the specific outcomes of community resources and programs, as opposed to institutional ones. Uniquely, local organizations are equal partners in the study. In the past, even when prostate cancer researchers worked with community organizations, the researchers led the work, without community input.
Such partnerships take more time, effort, and resources than conventional research—but they are more likely to lead to meaningful change within communities and organizations, Dr. Washington said. PCF’s support is key to this work, he added. “I am glad that PCF is interested in all aspects of prostate cancer care, as shown by the projects PCF funds and supports, and how they promote the integration of this work through research meetings and collaboration.”
