Prostate Cancer Surgeries Plummeted for Black Men in 2020

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During the initial COVID-19 lockdown, the odds of Black men undergoing surgery for untreated nonmetastatic prostate cancer dropped by 94%, but for White men, there was no change, new data show.

Before the pandemic, “there was no difference between White and Black patients” in terms of getting the surgery, said Adrien Bernstein, MD, a urologic oncology fellow at Fox Chase Cancer Center in Philadelphia.

He and his colleagues conducted a retrospective, multi-institution cohort study comparing prostatectomy rates during the first COVID wave (March to May 2020) with rates during the same months in 2019.

They used the Pennsylvania Urologic Regional Collaborative (PURC) — which gathers data from academic and private institutions in urban and rural settings — to evaluate men diagnosed with nonmetastatic prostate cancer.

Of the 647 men with localized prostate cancer, 269 received care during the 2020 study period and 378 received care during the 2019 period, Bernstein reported at the American Urological Association 2021 Annual Meeting.

In 2020, surgery was significantly less likely for Black than for White men (1.3% vs 25.9%; < .001), despite similar COVID-19 risk factors, biopsy grade, and comparable 2019 surgery rates (17.7% vs 19.1%; = .75).

On regression analysis, after adjustment for covariates, the odds of prostatectomy for Black men dropped to 6% in 2020 (odds ratio [OR], 0.06; 95% CI, 0.007 - 0.43; P = .006), with no change for White patients (OR, 1.41, 95% CI, 0.89 - 2.21;= .142).

“In a multivariable analysis, adjusted for the presence of high-risk disease and age, White men were 31 times more likely to receive surgical care during the lockdown period than Black patients,” Bernstein said.

Early in the pandemic, many resources were diverted from cancer care to COVID care, leaving many patients, including those with prostate cancer, with limited or no access to surgery, he explained.

Although localized prostate cancer does not require immediate treatment, the study highlights systemic inequities, the team writes in their abstract.

Surgical Volume Varied by Site

“The degree to which sites reduced surgery during the first wave varied substantially,” with some sites increasing surgical volume by 33% and others shutting down completely, said Bernstein. “Notably, sites that cared for more Black patients were those most impacted by the lockdown.”

“Lessons from the study are applicable to all patients and should drive efforts to recognize and offset the implications of our pandemic-related decisions by prioritizing care in underserved communities,” he said.

Another glaring racial gap was revealed in a study presented at the meeting by Ali Mouzannar, MD, a urology resident with the University of Miami.

Although the US Food and Drug Administration approved sipuleucel-T (Provenge) as the first and only immunotherapy treatment for metastatic castration-resistant prostate cancer in 2010, the increase in use of the novel agent — from 3.8% in 2010 to 39.8% in 2013 — was mainly seen in White men. Black and Hispanic patients saw a disproportionately low increase and were more likely to continue with chemotherapy.

Black and Hispanic men have a high burden of prostate cancer, Mouzannar explained during a press briefing, so access to the most cutting-edge treatments is critical.

Black, Hispanic Men at Higher Risk

The risk of dying from prostate cancer is 2.5-fold greater for Black men than for White men, according to a 2015 study. And rates of prostate cancer are higher in Hispanic men than in White men, and survival is worse.

This drop in surgeries is “jarring,” said Brian K. McNeil, MD, MBA, associate dean for clinical affairs and vice chair of the Department of Urology at SUNY Downstate Health Sciences University in Brooklyn, New York.

Because the pandemic struck urban areas particularly hard, Black men might have had less access to surgery because of where they live. “Still, it was a bit shocking,” he told Medscape Medical News.

Access to sipuleucel-T was no doubt complicated by the high price and the cultural mistrust surrounding a drug in which cells are essentially harvested, reprogrammed to attack cancer cells, and put back in the body, he said.

But the bottom line is that all races must have equitable access to the most promising treatments. Both these studies, along with others presented at the meeting, drive home the point that “disparities do exist,” McNeil said.

Research on the underlying roots of disparities and education is needed. “We need to educate not only patients, but also urologists ourselves, about disparities,” he said.

Bernstein, Mouzannar, and McNeil have disclosed no relevant financial relationships.

American Urological Association (AUA) 2021 Annual Meeting: Abstracts PD03-02 and PD34-03. Presented September 21, 2021.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube

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