Can targeting women with behavioural science ‘nudges’ help black men to find out more about their high risk of contracting prostate cancer?

327 Background: Though Black men with prostate cancer are more likely to have aggressive disease features than White men, race-specific differences in initial treatment responses in localized disease remains unknown. Methods: Individual patient data were obtained for 9259 patients (including 1674 [18.1%] Black men and 7585 [81.9%] White men) enrolled on eight randomized controlled trials evaluating definitive radiotherapy (RT) ± short-term or long-term androgen deprivation therapy (STADT and LTADT). The primary endpoints were biochemical recurrence (BCR), distant metastasis (DM), and prostate cancer-specific mortality (PCSM). Fine-Gray subdistribution HR (sHR) models were developed to evaluate the cumulative incidences of all endpoints after stratification by National Comprehensive Cancer Network risk grouping. A meta-analysis was done to estimate pair-wise comparisons of treatments within and between Black and White men, after adjusting for age, Gleason score, clinical T stage, and initial PSA. Results: Black men were more likely to have NCCN high-risk disease at enrollment (656/1674 [39.2%] vs 2506/7585 [33%], p<0.001). However, within the high-risk stratum Black men had lower 10-year rates of BCR (46.1% vs. 50.4%, p=0.02), DM (14% vs. 21.6%, p<0.001), and PCSM (4.9% vs. 9.8%, p<0.001). After adjusting for age and disease characteristics, Black men with high-risk prostate receiving RT+STADT had lower rates of BCR (sHR 0.73, 95% CI 0.62-0.86, p<0.001), DM (sHR 0.64, 95% CI 0.49-0.84, p=0.001) and PCSM (sHR 0.49, 95% CI 0.25-0.95, p=0.04). There were no differences in BCR, DM, or PCSM among men receiving RT+LTADT. The interaction between race and the impact of adding STADT to RT alone on BCR was statistically significant (p=0.003). Conclusions: Black men enrolled on randomized trials with long-term follow-up have higher risk disease at enrollment, but have better BCR, DM, and PCSM outcomes with RT-based therapy compared with White men, particularly with the addition of STADT.

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Getting Black Men to Undergo Prostate Cancer Screening

American Journal of Men s Health ◽

10.1177/1557988314546491 ◽

2014 ◽

Vol 9 (5) ◽

pp. 385-396 ◽

Cited By ~ 21

Author(s):

Lorraine T. Dean ◽

S. V. Subramanian ◽

David R. Williams ◽

Katrina Armstrong ◽

Camille Zubrinsky Charles ◽

...

Keyword(s):

Prostate Cancer ◽

Social Capital ◽

High Risk ◽

Black Men ◽

African American Men ◽

Self Report ◽

Screening Tools ◽

Psa Test ◽

Psa Testing ◽

Screening Behaviors

Despite higher rates of prostate cancer–related mortality and later stage of prostate cancer diagnosis, Black/African American men are significantly less likely than non-Hispanic White men to use early detection screening tools, like prostate-specific antigen (PSA) testing for prostate cancer. Lower screening rates may be due, in part, to controversy over the value of prostate cancer screenings as part of routine preventive care for men, but Black men represent a high-risk group for prostate cancer that may still benefit from PSA testing. Exploring the role of social factors that might be associated with PSA testing can increase knowledge of what might promote screening behaviors for prostate cancer and other health conditions for which Black men are at high risk. Using multilevel logistic regression, this study analyzed self-report lifetime use of PSA test for 829 Black men older than 45 years across 381 Philadelphia census tracts. This study included individual demographic and aggregated social capital data from the Public Health Management Corporation’s 2004, 2006, and 2008 waves of the Community Health Database, and sociodemographic characteristics from the 2000 U.S. Census. Each unit increase in community participation was associated with a 3 to 3.5 times greater likelihood of having had a PSA test (odds ratio = 3.35). Findings suggest that structural forms of social capital may play a role in screening behaviors for Black men in Philadelphia. A better understanding of the mechanism underlying the link between social capital and screening behaviors can inform how researchers and interventionists develop tools to promote screening for those who need it.

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Prostate Cancer Screening Among High-Risk Black Men

The Journal for Nurse Practitioners ◽

10.1016/j.nurpra.2018.07.005 ◽

2018 ◽

Vol 14 (9) ◽

pp. 677-682.e2

Author(s):

Lisa R. Roberts ◽

Colwick M. Wilson ◽

Laura Stiel ◽

Carlos A. Casiano ◽

Susanne B. Montgomery

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

High Risk ◽

Black Men ◽

Prostate Cancer Screening

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A community-based approach to educating black men in underserved communities about the risks and benefits of prostate cancer screening.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.99 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 99-99

Author(s):

Mark Wendell Kennedy ◽

Jacques Carter ◽

Stephen Wright ◽

Magnolia Contreras ◽

Karen Marie Winkfield

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Black Men ◽

Prostate Cancer Screening ◽

The United States ◽

Individual Risk ◽

Screening Methods ◽

Community Based ◽

Screening Programs ◽

High Risk Populations

99 Background: Black men have the highest incidence of prostate cancer (PCa) and are twice as likely to die of the disease than any other race/ethnic group in the United States. The recent controversy related to PCa screening may disproportionately impact black men who are already at greatest risk from the disease. This project sets out to develop culturally-competent educational and screening programs for men in high-risk populations so they can make an informed decision about PCa screening. Methods: A community-based education and screening program targeted towards black men living in an under-resourced community in Boston, MA was implemented. A mobile PCa screening van was initially employed and stationed at a local community health center (CHC) twice annually. Education about PCa screening was provided by a trained racially-concordant patient navigator (PN). Screening was available on the van by a primary care physician (PCP). In 2013, the pre-screening educational model was incorporated into the clinical practice of a single PCP practicing at the CHC. Every male patient over the age of 40 had an educational consultation about PCa screening with the PN before seeing their PCP. The patient would then discuss screening with the doctor and decide whether to proceed at that visit. Results: From 2004 to 2013, 20 van visits were conducted at the CHC. Two-hundred seven (207) men received PCa screening education; 179 (86.5%) elected to undergo screening. Of the men screened, 26 (14.5%) were referred for further testing as a result of their screening test. From January 2013 to September 2014, 121 men received PCa education; 100 men (82.6%) were screened. Ninety percent had both prostate-specific antigen testing and a digital rectal exam. Conclusions: These data suggest that formal PCa screening education prior to meeting with a physician is welcomed and may be a way to increase baseline screening in high risk populations. This provides an opportunity to develop an individualized prostate health management program based on individual risk profiles and to carefully monitor PSA fluctuations. The ultimate goal is to reduce unnecessary interventions while capturing PCa early in men at greatest risk.

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