Race and Medicine

Race and Medicine

Disclosures: Tewari reports no relevant financial disclosures.
March 05, 2021
4 min read
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Focused approach needed to reduce prostate cancer incidence, mortality among Black men

Disclosures: Tewari reports no relevant financial disclosures.
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Greater effort is urgently needed to address substantial disparities in prostate cancer incidence and mortality among Black men, according to a review published in Cancer Reports.

For instance, genomic profiling of the tumor microenvironment can help better understand the prostate cancer burden among Black men and allow for more personalized, aggressive treatment, according to the review authors, who added that risk-stratifying these men based on the genomic findings also may help to increase their clinical trial participation.

Ashutosh K. Tewari, MD, chair of the department of urology at Mount Sinai Health System

“Prostate cancer-associated mortality is twofold higher among Black men compared with any other race, and this is of great concern,” Ashutosh K. Tewari, MD, chair of the department of urology at Mount Sinai Health System, said during an interview with Healio.Although we start with a cancer that appears to be a bit more aggressive molecularly in Black men, if we find the prostate cancer earlier, then we can treat it effectively.”

Tewari spoke with Healio about what prompted this review, the key takeaways, a mobile MRI initiative intended to increase access to prostate cancer screening in the Black community and what clinicians can do today to help overcome this disparity.

Healio: What prompted this review?

Tewari: I have been treating patients with prostate cancer for more than 25 years. Early in my career, I lived in Detroit, Michigan, where 40% of men diagnosed with prostate cancer were Black. When I saw that Black men also had a higher mortality rate, I decided to get involved in research looking into the mechanisms at play. I am now practicing in New York City, where I have been for the past 17 years. Here, the number of Black men with prostate cancer is about 10% to 15% of the population and, alarmingly, mortality rates are still twofold higher than any other race diagnosed with the disease. Because of this, I wanted to make a change in survival rates for these men — among whom the problem appears to be worse than for any other group. Also, if we were able to identify the problem in this group, then we could perhaps identify the problem in other groups, as well.

Healio: What are some of the key takeaways?

Tewari: We learned that this is a complex issue. Mortality is not happening because of one thing. There is an interplay between the prostate cancer itself, which appears different among Black men; the patient, for whom “the soil” appears very different; and what the patient did once they were diagnosed, such as whether and when they sought medical treatment.

Healio: Are there certain risk factors at play?

Tewari: Black men are more likely to have metabolic syndrome, hypertension and an inflamed body constitution. There are also certain hormonal aspects that may impact the risk for prostate cancer. On the cellular level, this cancer can be driven by many factors. In addition, some cancers are driven by sugars, others are driven by male hormones and many are driven by inflammation in the body. Delay in seeking medical care can have a significant impact on prostate cancer mortality.

There are also trust issues. For example, some individuals do not trust doctors and this in and of itself is a risk behavior. All these combined are what leads to the higher mortality rates among Black men.

Healio: What can clinicians do today to help overcome this disparity?

Tewari: We need to find and diagnose prostate cancer in Black men earlier, because if we find it earlier, we can treat it effectively and have the same cure rates as in other patient populations. Early detection also will help in identifying appropriate candidates for active surveillance, thus avoiding side effects without compromising survival among Black men. This is the main driving force for our research and, in the review, we discussed the importance of considering a more aggressive approach to treatment as it is a more aggressive cancer type. Clinicians should offer all types of genomic analysis, the latest therapies, hormonal therapies, and robotic and radiation treatments.

Clinicians need to appreciate that there is a difference between races and ethnicities and create a plan that is applicable to a particular ethnic group. What works for one group may not work for another group, so we need to have an ethnically sensitive approach to finding the prostate cancer. We need to encourage our Black patients to get tested, build a relationship with them and build trust. This way, they will share their problems and we can then diagnose their disease earlier and treat it appropriately.

Healio: Can you describe the impetus behind the Robert F. Smith Mobile MRI Unit initiative?

Tewari: The first step to early detection starts with awareness. We came up with this idea because this patient population was not coming to us, so we can now come to them. We are making things easier for high-risk groups who may have difficulty in getting to the doctor’s office. Our mobile unit is a well-equipped van in which testing and imaging can be done easily and could potentially save their life. The program will launch later this year and the van will appear in areas of New York City where there are higher Black populations, such as Harlem, Queens and the Bronx. Also, although our focus is on Black men, men of any race and ethnicity can participate.

Healio: What do you hope this mobile unit will provide for this patient population?

Tewari: We are aiming to provide a symbol of hope, an ease of access to proper health care and a tangible benefit in saving lives. My hope is that we will be able to continue doing this for the next 5 to 10 years and, in turn, see more men alive because we found their cancer early and were able to effectively treat it and provide a cure for them. If we find this cancer early, we can tackle it and treat it and ultimately make a difference in so many lives.

For more information:

Ashutosh K. Tewari, MD, can be reached at Icahn School of Medicine at Mount Sinai, Gustave L. Levy Place, New York, NY 10029; email: ash.tewari@mountsinai.org.