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Men's Health: Racial gap in prostate cancer recurrence remains a mystery

Survival shortfall persists in African-American men despite greater experience of hospitals and surgeons

African-American men are known to have a lower survival rate in the five years following a diagnosis of prostate cancer than Caucasian men, but researchers remain at a loss for an explanation.

Differences in medical care is one possibility, but a recent study shows the racial gap in survival occurs regardless of whether or not black patients receive surgery at experienced hospitals or from surgeons who perform a large number of prostate cancer surgeries.

“This suggests that other factors may need to be investigated as possible contributors to the racial disparity in prostate cancer recurrence, such as lifestyle factors and clinical characteristics of the tumour,” says researcher Kyna Gooden of the Shaw-University of North Carolina Center for Prostate Cancer Research in Raleigh, N.C.

She and her colleagues examined data on 962 black and 7,387 white men diagnosed with prostate cancer between 1993 and 1999 who had undergone surgery within six months of a diagnosis.

During the seven-year study period, black men were 32 per cent more likely to experience disease recurrence, and further examination of this imbalance showed the racial differences were even greater in more experienced high-volume hospitals than in low-volume hospitals.

In high-volume hospitals, black men were 66 per cent more likely to experience disease recurrence, while in low-volume hospitals they were 24 per cent more likely to have a recurrence. The disparity was lower among those receiving care at medium- and medium-high-volume hospitals, were black patients were only 12 per cent and 19 per cent more likely to experience recurrence, respectively.

When researchers looked at the experience of individual surgeons, they found a similar increase in racial differences in prostate cancer recurrence between low-, medium- and medium-high-volume physicians. However, patients of high-volume surgeons did show slightly lower racial differences than those of medium-volume surgeons.