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Graham NJ, Souter LH, Salami SS. A Systematic Review of Family History, Race/Ethnicity, and Genetic Risk on Prostate Cancer Detection and Outcomes: Considerations in PSA-based Screening. Urol Oncol 2024:S1078-1439(24)00504-0. [PMID: 39013715 DOI: 10.1016/j.urolonc.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/25/2024] [Accepted: 06/02/2024] [Indexed: 07/18/2024]
Abstract
AIM To investigate the role of family history, race/ethnicity, and genetics in prostate cancer (PCa) screening. METHODS We conducted a systematic review of articles from January 2013 through September 2023 that focused on the association of race/ethnicity and genetic factors on PCa detection. Of 10,815 studies, we identified 43 that fulfilled our pre-determined PICO (Patient, Intervention, Comparison and Outcome) criteria. RESULTS Men with ≥1 first-degree relative(s) with PCa are at increased risk of PCa, even with negative imaging and/or benign prostate biopsy. Black men have higher PCa risk, while Asian men have lower risk. Most of the differences in risks are attributable to environmental and socioeconomic factors; however, genetic differences may play a role. Among numerous pathogenic variants that increase PCa risk, BRCA2, MSH2, and HOXB13 mutations confer the highest risk of PCa. Polygenic risk score (PRS) models identify men at higher PCa risk for a given age and PSA; these models improve when considering other clinical factors and when the model population matches the study population's ancestry. CONCLUSIONS Family history of PCa, race/ethnicity, pathogenic variants (particularly BRCA2, MSH2, and HOXB13), and PRS are associated with increased PCa risk and should be considered in shared decision-making to determine PCa screening regimens.
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Affiliation(s)
| | | | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI.
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Bamidele O, Greenley S, Ukoha-Kalu BO, Titus OF, Nanton V. A Scoping Review of Stigma Related to Prostate Cancer in Black Men. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02070-5. [PMID: 38980523 DOI: 10.1007/s40615-024-02070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Prostate cancer (CaP) disproportionately affects 1-in-4 Black men and is a stigmatised disease within their communities. Yet, Black men are underrepresented in CaP research concerning stigma, which necessitates a scoping review to map available evidence on this topic to inform future research. AIMS To map published literature on stigma related to CaP in Black men to understand their experiences and/or perceptions and identify directions for future research. METHODS A scoping review was conducted using the five-step framework by Arksey and O'Malley. Studies published in English addressing stigma related to CaP from the perspectives of Black men and/or their families were included. We searched six databases including Medline, Embase, PsycInfo, CINAHL, Web of Science Core Collection and Google Scholar, from inception to April 2023. Citation searches were also conducted. Two independent reviewers conducted screening and data extraction. Data was synthesised using descriptive content analysis. RESULTS Thirty-four eligible studies conducted in the USA, UK, Trinidad and Tobago, South Africa, Cameroon and Canada from 1995 to 2023 were included. A total of 1867 Black men with/without a CaP diagnosis and 145 adult partners were included. Review findings showed a complex intersection of self-stigma, public stigma and structural stigma impacted Black men's perceptions of their masculinity. While men's experiences/perceptions of stigma varied depending on their illness status, there were commonalities in their masculinity concerns (underpinned by stigma), which influenced their attitude towards digital rectal examination, post-treatment side effects and social interactions on CaP. These have implications for public health messaging on CaP within Black communities, as well as patient-provider interactions with the men. CONCLUSIONS This novel review highlights the need to pay attention to how CaP is presented to Black men and their communities using avenues and languages that are culturally acceptable and empower them to negotiate self-stigma, public stigma and structural stigma related to CaP. Directions for further research were also identified.
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Affiliation(s)
- Olufikayo Bamidele
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
| | - Sarah Greenley
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
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Labban M, Stone BV, Steele GL, Salinas KE, Agudile E, Katz MH, Rihan-Porter N, Reich AJ, Cole AP, Landers S, Trinh QD. A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts. Cancer 2024. [PMID: 38837334 DOI: 10.1002/cncr.35366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. METHODS Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. RESULTS Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. CONCLUSIONS This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. PLAIN LANGUAGE SUMMARY Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.
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Affiliation(s)
- Muhieddine Labban
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin V Stone
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Emeka Agudile
- Department of Internal Medicine, Carney Hospital, Boston, Massachusetts, USA
| | - Mark H Katz
- Department of Urology, Boston Medical Center, Boston, Massachusetts, USA
| | - Nancy Rihan-Porter
- Cambridge Health Alliance and Cambridge Public Health Department, Equity, Resilience, and Preparedness, Boston, Massachusetts, USA
| | - Amanda J Reich
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexander P Cole
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stewart Landers
- Division of Health Services, John Snow Inc., Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Minamitani M, Katano A, Mukai T, Ohira S, Nakagawa K. Comparative analysis of treatment decision-making in patients with localized prostate and cervical cancer: what influences receiving surgery or radiotherapy? Support Care Cancer 2024; 32:391. [PMID: 38806815 PMCID: PMC11133204 DOI: 10.1007/s00520-024-08589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE This study focused on identifying the factors influencing the decision-making process in patients with localized prostate and cervical cancer in Japan and specifically examining the choice between surgery and radiotherapy. METHODS Patients with specific cancer stages registered with a healthcare research company for whom radical surgery or radiotherapy was equally effective and recommended participated in this cross-sectional online survey. RESULTS The responses of 206 and 231 patients with prostate and cervical cancer, respectively, revealed that both groups relied heavily on the physicians' recommendations (prostate: odds ratio (OR) = 40.3, p < 0.001; cervical: OR = 5.59, p < 0.001) and their impression of radiotherapy (prostate: OR = 9.22, p < 0.001; cervical: OR = 2.31, p < 0.001). Factors such as hypertension (OR = 6.48, p < 0.05), diabetes mellitus (OR = 9.68, p < 0.05), employment status (OR = 0.08, p < 0.01), and impressions of surgery (OR = 0.14, p < 0.01) also played a significant role in patients with prostate cancer. In contrast, the specialty of the physician (OR = 4.55, p < 0.05) proposing the treatment influenced the decision-making process of patients with cervical cancer. Information sources varied between the two groups: patients with prostate cancer were more inclined towards printed materials, whereas patients with cervical cancer were more inclined towards interpersonal relationships. CONCLUSION Although several limitations, such as the sample and recall bias, were noted, this study emphasizes the role of psychosocial factors in the decision-making process and the requirement for tailored information sources.
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Affiliation(s)
- Masanari Minamitani
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tomoya Mukai
- Department of Psychology, Fukuyama University, 985-1Higashimura-Machi, SanzoFukuyama-City, Hiroshima, 729-0292, Japan
| | - Shingo Ohira
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Keiichi Nakagawa
- Department of Comprehensive Radiation Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
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Subramanian L, Hawley ST, Skolarus TA, Rankin A, Fetters MD, Witzke K, Chen J, Radhakrishnan A. Patient perspectives on factors influencing active surveillance adherence for low-risk prostate cancer: A qualitative study. Cancer Med 2024; 13:e6847. [PMID: 38151901 PMCID: PMC10807559 DOI: 10.1002/cam4.6847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Prostate cancer is the most common cancer among men in the United States. Treatment guidelines recommend active surveillance for low-risk prostate cancer, which involves monitoring for progression, to avoid or delay definitive treatments and their side effects. Despite increased uptake, adherence to surveillance remains a challenge. METHODS We conducted semi-structured, qualitative, virtual interviews based on the Theoretical Domains Framework (TDF), with men (15) who were or had been on active surveillance for their low-risk prostate cancer in 2020. Interviews were transcribed and coded under TDF's behavioral theory-based domains. We analyzed domains related to adherence to surveillance using constructivist grounded theory to identify themes influencing decision processes in adherence. RESULTS The TDF domains of emotion, beliefs about consequences, environmental context and resources, and social influences were most relevant to surveillance adherence-. From these four TDF domains, three themes emerged as underlying decision processes: trust in surveillance as treatment, quality of life, and experiences of self and others. Positive perceptions of these three themes supported adherence while negative perceptions contributed to non-adherence (i.e., not receiving follow-up or stopping surveillance). The relationship between the TDF domains and themes provided a theoretical process describing factors impacting active surveillance adherence for men with low-risk prostate cancer. CONCLUSIONS Men identified key factors impacting active surveillance adherence that provide opportunities for clinical implementation and practice improvement. Future efforts should focus on multi-level interventions that foster trust in surveillance as treatment, emphasize quality of life benefits and enhance patients' interpersonal experiences while on surveillance to optimize adherence.
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Affiliation(s)
- Lalita Subramanian
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah T. Hawley
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Ted A. Skolarus
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Department of Surgery, Urology SectionUniversity of ChicagoChicagoIllinoisUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | - Karla Witzke
- Department of UrologyMyMichigan HealthMidlandMichiganUSA
| | - Jason Chen
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Archana Radhakrishnan
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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Guan A, Santiago-Rodríguez EJ, Chung BI, Shim JK, Allen L, Kuo MC, Lau K, Loya Z, Brooks JD, Cheng I, DeRouen MC, Frosch DL, Golden T, Leppert JT, Lichtensztajn DY, Lu Q, Oh D, Sieh W, Wadhwa M, Cooperberg MR, Carroll PR, Gomez SL, Shariff-Marco S. Patient and physician perspectives on treatments for low-risk prostate cancer: a qualitative study. BMC Cancer 2023; 23:1191. [PMID: 38053037 PMCID: PMC10696696 DOI: 10.1186/s12885-023-11679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa. METHODS Semi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area. RESULTS Patients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians' perceptions largely mirrored patients' perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients' prior knowledge and the support of family/friends as facilitators of clinical conversations. CONCLUSIONS Our study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.
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Affiliation(s)
- Alice Guan
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Eduardo J Santiago-Rodríguez
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Benjamin I Chung
- Department of Urology, Stanford University, Palo Alto, United States
| | - Janet K Shim
- UCSF | Department of Social & Behavioral Sciences, San Francisco, United States
| | - Laura Allen
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Mei-Chin Kuo
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Kathie Lau
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Zinnia Loya
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - James D Brooks
- Department of Urology, Stanford University, Palo Alto, United States
| | - Iona Cheng
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Mindy C DeRouen
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Dominick L Frosch
- Health Science Diligence Advisors, LLC, San Francisco, United States
| | - Todd Golden
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - John T Leppert
- Department of Urology, Stanford University, Palo Alto, United States
| | - Daphne Y Lichtensztajn
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Qian Lu
- Dept of Health Disparities Research, University of Texas MD-Anderson Cancer Center, Houston, United States
| | - Debora Oh
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Weiva Sieh
- Dept of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Michelle Wadhwa
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Matthew R Cooperberg
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
- UCSF | Department of Urology, San Francisco, United States
| | | | - Scarlett L Gomez
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States
| | - Salma Shariff-Marco
- Dept of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, United States.
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