Medical distrust is one of the reasons African American patients are more likely to regret their choice of prostate cancer treatment, suggests a study in the Journal of Urology®, the official gazette of the American Urological Association (AUA). The magazine is published by Wolters Kluwer in the Lippincott portfolio.
Masculinity concerns also add to the regret of the decision among African American men with localized prostate cancer, according to the new study by Dr. Molly DeWitt-Foy and colleagues at the Cleveland Clinic.
Our results could help identify new approaches to reducing racial disparities in risk and treatment outcomes for African American men with prostate cancer. "
Dr. DeWitt-Foy, Wolters Kluwer Health
Belief in prostate cancer helps explain racial differences
The study included 1,112 men, mean age 63, who were treated for localized prostate cancer between 2010 and 2016. Because their cancer has not spread beyond the prostate, patients with localized disease have a choice of treatment options, including active monitoring and hormone therapy, radiation, surgery, or watchful waiting.
Approximately 40 percent of the patients in the study were African American, while 60 percent were from other racial / ethnic groups.
Most of the medical characteristics were similar for African Americans compared to non-African Americans. The initial treatment consisted of an operation (prostatectomy) in around 50 percent of the patients and radiation (brachytherapy) in 42 percent.
The men completed a series of surveys, including a redesigned Belief In Prostate Cancer Questionnaire (PCBQ).
Based on previous studies of racial differences in cultural beliefs relating to health care, the PCBQ aimed to better understand cancer-related beliefs and experiences with the diagnosis, treatment, recovery, and survival of prostate cancer.
Treatment outcomes for prostate cancer were generally similar between groups, including problems with urinary incontinence, bowel function, and hormonal symptoms.
African American men had lower scores for sexual function compared to non-African American men. Despite similar results, African American men had higher mean regret scores: about 45 versus 35 (on a 100-point scale).
There were also some racial differences in the responses to the PCBQ. "African-American men showed greater concerns about masculinity and more medical distrust than non-African-American men," write Dr. DeWitt-Foy and co-authors.
African American patients were more likely to say that their doctor treated them differently because of their race – although 80 percent of them disagreed with that statement. African American patients were also more likely to feel that screening and treatment for prostate cancer "made them feel less like men".
When adjusted for other factors, African American patients were more than twice as likely to have high regrets about treatment for prostate cancer.
Medical suspicions and concerns about masculinity explained some of the effects of the breed on the deplorable. Regardless of race, poorer sexual function and poorer urinary incontinence – two major side effects of treating prostate cancer – also predicted higher levels of regret for the decision.
Despite advances over the past 20 years, African American men are still more likely to be diagnosed and dying of prostate cancer. The new study aimed to better understand patients' beliefs about prostate cancer and ultimately reduce treatment-related decision-making.
The results confirm that African American men have higher regrets about their prostate cancer treatment, and suggest that those regrets are related to medical suspicions and concerns about masculinity. Dr. DeWitt-Foy and colleagues conclude:
"This information can help educate patient counseling and has the potential to reduce racial disparities in the experiences of prostate cancer patients by targeting educational opportunities and improved communication."