Understanding Health Equity in Prostate Cancer

Prostate cancer is the most frequently diagnosed cancer in people assigned male at birth. We have gotten better at finding and treating both early and advanced stages of this cancer. But not everyone gets the same benefits from these improvements. Because of racism, discrimination, social, and economic challenges that have happened in the past and continue to happen today, many people don't have the same access or chances to get the care they need. As a result, many people face more challenges when it comes to preventing, detecting, treating, and surviving prostate cancer. These differences in healthcare outcomes are known as health disparities, and they prevent communities that haven't been treated fairly in the past from being as healthy as they could be.

When we look at all types of cancers together, there are differences in how they are diagnosed, the number of deaths, and how long people survive based on their race and ethnicity. Sadly, prostate cancer has the biggest disparities among all the cancers, especially for African American/Black people. They have the worst health outcomes when it comes to prostate cancer. Compared to White people with prostate cancer, Black people are more than 1.7 times as likely to be diagnosed with it, and they are 2.1 times more likely to die from it.

We don't have enough research about how prostate cancer affects other racial and ethnic groups, which makes it harder to figure out the best care for them. But from what we have learned so far, it seems that Hispanic/Latino people are less likely to be diagnosed with prostate cancer compared to White people. However, when they are diagnosed, it's often at a more advanced stage. Similarly, some Asian communities also tend to have advanced or metastatic prostate cancer when they are diagnosed. Recent studies have also found that American Indian and Alaska Native (AI/AN) people are not getting screened for prostate cancer as much as other racial groups. However, they have a higher chance of dying from prostate cancer.

Education, income and wealth are directly related to a person's health. These factors are known as socio-economic status. For cancer patients, these factors become even more important in getting the help and treatment they need. But because healthcare in the United States is so expensive, it can be extremely hard for someone to get the right care if they have a lower income or no health insurance.

For people facing financial difficulties and who are also at risk of prostate cancer, these problems can be even more challenging. People with lower incomes are less likely to get checked for prostate cancer because it's harder for them to get access to medical services. They also have a higher chance of being diagnosed with advanced prostate cancer, which needs more complicated and expensive care. The rising prices of medications and treatments lead to higher out-of-pocket costs, which cause even more financial problems.

These financial problems caused by the high treatment costs and their effects are known as financial toxicity. Financial toxicity often makes patients feel forced to make tough decisions about their treatment. Some may decide to skip taking their medications, try to stretch out their supply of medicines, or even decide not to get treatment at all. As a result, many patients suffer and experience negative outcomes. These can include having a lower quality of life, not getting the best care, and even a higher chance of dying.

When it comes to preventing, finding, treating, and surviving prostate cancer, a person's zip code is as important as their genetic code. Recent studies show that this is especially the case for people at risk for prostate cancer who live in rural areas and in places that are in economic distress. In these communities, those at risk for prostate cancer are less likely to get PSA screenings and less likely to have access to medical care. But unfortunately, they are more likely to find out they have prostate cancer when it's already advanced, and they are also more likely to die from it.

The reasons for these differences can be complex and have many factors involved. But the main cause is that some people don't have the same access to medical tests and treatments. People who live in low-income areas might struggle to pay for the care they need to treat their cancer. Those in rural communities face similar financial problems, but they also have fewer resources and need to travel long distances to get quality care because most hospitals and cancer centers are located in cities.

Along with the differences in race, culture, finances, and areas of residence that cause health disparities in prostate cancer, there is also a problem with not having enough education about it. Many communities and people in the United States don't know much about how to find, treat, and recover from prostate cancer. Some people who are at risk for prostate cancer don't get clear information from their healthcare providers, and even if they do, it can be hard to understand and know how it applies to them. These problems affect the Black/African-American community, communities of color, and people with lower incomes more than others.

Not knowing enough about prostate cancer can also make those at risk feel scared and unsure. This might make them not want to get regular screenings and could discourage them from talking to their doctor. But research shows that education programs in local communities can help people learn more about prostate cancer and understand it better. This can help them make decisions together with their doctor about getting screened, especially in communities that are the highest risk of getting the disease.