Racial Disparities and Mental Health Effects Within Prostate Cancer

Disparities in prostate cancer (PCa) exist at all stages: screening, diagnosis, treatment, outcomes, and mortality. Although there are a multitude of complex biological (e.g., genetics, age at diagnosis, PSA levels, Gleason score) and nonbiological (e.g., socioeconomic status, education level, health literacy) factors that contribute to PCa disparities, nonbiological factors may play a more significant role. One understudied aspect influencing PCa patients is mental health related to the quality of life. Overall, PCa patients report poorer mental health than non-PCa patients and have a higher incidence of depression and anxiety. Racial disparities in mental health, specifically in PCa patients, and how poor mental health impacts overall PCa outcomes require further study.
1. Karakas C, Wang C, Deng F, Huang H, Wang D, Lee P. Molecular mechanisms involvingprostate cancer racial disparity. Am J Clin Exp Urol. 2017;5(3):34-48.
2. Das H, Rodriguez R. Health Care Disparities in Urologic Oncology: A Systematic Review. Urology. 2020;136:9-18. doi:10.1016/j.urology.2019.09.058
3. Powell IJ, Dyson G, Land S, et al. Genes Associated with Prostate Cancer Are Differentially Expressed in African American and European American Men. Cancer Epidemiol Biomarkers Prev. 2013;22(5):891-897. doi:10.1158/1055-9965.epi-12-1238
4. Nyame YA, Cooperberg MR, Cumberbatch MG, et al. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol. 2022;82(4):341-351. doi:10.1016/j.eururo.2022.03.007
5. Krimphove MJ, Cole AP, Fletcher SA, et al. Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis. 2019;22(1):125-136. doi:10.1038/s41391-018-0083-4
6. Friedlander DF, Trinh QD, Krasnova A, et al. Racial Disparity in Delivering Definitive Therapy for Intermediate/High-risk Localized Prostate Cancer: The Impact of Facility Features and Socioeconomic Characteristics. Eur Urol. 2018;73(3):445-451. doi:10.1016/j.eururo.2017.07.023
7. Lediju O, Ikuemonisan J, Salami SS, Adejoro O. Racial Disparities in the Presentation, Early Definitive Surgical Treatment, and Mortality Among Men Diagnosed with Poorly Differentiated/Undifferentiated Non-metastatic Prostate Cancer in the USA. J Racial Ethn Health Disparities. 2019;6(2):401-408. doi:10.1007/s40615-018-00537-w
8. Mahran A, Mishra K, Bukavina L, et al. Observed racial disparity in the negative predictive value of multi-parametric MRI for the diagnosis for prostate cancer. Int Urol Nephrol. 2019;51(8):1343-1348. doi:10.1007/s11255-019-02158-6
9. Smith ZL, Eggener SE, Murphy AB. African-American Prostate Cancer Disparities. Curr Urol Rep. 2017;18(10):81. doi:10.1007/s11934-017-0724-5
10. Lachance J, Berens AJ, Hansen MEB, Teng AK, Tishkoff SA, Rebbeck TR. Genetic Hitchhiking and Population Bottlenecks Contribute to Prostate Cancer Disparities in Men of African Descent. Cancer Res. 2018;78(9):2432-2443. doi:10.1158/0008-5472.can-17-1550
11. Cao Z, Xu Y, Guo F, et al. FASN Protein Overexpression Indicates Poor Biochemical Recurrence-Free Survival in Prostate Cancer. Dis Markers. 2020;2020(3904947):1-9. doi:10.1155/2020/3904947
12. Nguyen PL, Ma J, Chavarro JE, et al. Fatty acid synthase polymorphisms, tumor expression, body mass index, prostate cancer risk, and survival. J Clin Oncol. 2010;28(25):3958-3964. doi:10.1200/jco.2009.27.0793
13. Myers JS, von Lersner AK, Sang QXA. Proteomic Upregulation of Fatty Acid Synthase and Fatty Acid Binding Protein 5 and Identification of Cancer- and Race-Specific Pathway Associations in Human Prostate Cancer Tissues. J Cancer. 2016;7(11):1452-1464. doi:10.7150/jca.15860
14. Lopez DS, Advani S, Tsilidis KK, Wang R, Canfield S. Endogenous and exogenous testosterone and prostate cancer: decreased-, increased- or null-risk? Transl Androl Urol. 2017;6(3):566-579. doi:10.21037/tau.2017.05.35
15. Allott EH, Howard LE, Aronson WJ, et al. Racial differences in the association between preoperative serum cholesterol and prostate cancer recurrence: results from the SEARCH database. Cancer Epidemiol Biomark Prev. 2016;25(3):547-554. doi:10.1158/1055-9965.epi-15-0876
16. Lowder D, Rizwan K, McColl C, et al. Racial disparities in prostate cancer: A complex interplay between socioeconomic inequities and genomics. Cancer Lett. 2022;531:71-82. doi:10.1016/j.canlet.2022.01.028
17. Dess RT, Hartman HE, Mahal BA, et al. Association of Black Race With Prostate Cancer–Specific and Other-Cause Mortality. JAMA Oncol. 2019;5(7):975-983. doi:10.1001/jamaoncol.2019.0826
18. Klebaner D, Courtney PT, Garraway IP, et al. Association of Health-Care System With Prostate Cancer-Specific Mortality in African American and Non-Hispanic White Men. J Natl Cancer Inst. 2021;113(10):1343-1351. doi:10.1093/jnci/djab062
19. Freeman VL, Ricardo AC, Campbell RT, Barrett RE, Warnecke RB. Association of census tract-level socioeconomic status with disparities in prostate cancer-specific survival. Cancer Epidemiol Biomark Prev. 2011;20(10):2150-2159. doi:10.1158/1055-9965.epi-11-0344
20. Daskivich TJ, Kwan L, Dash A, Litwin MS. Racial parity in tumor burden, treatment choice and survival outcomes in men with prostate cancer in the VA healthcare system. Prostate Cancer Prostatic Dis. 2015;18(2):104-109. doi:10.1038/pcan.2014.51
21. Freedland SJ, Vidal AC, Howard LE, et al. Race and risk of metastases and survival after radical prostatectomy: Results from the SEARCH database. Cancer. 2017;123(21):4199-4206. doi:10.1002/cncr.30834
22. Vigneswaran HT, Jagai JS, Greenwald DT, et al. Association between environmental quality and prostate cancer stage at diagnosis. Prostate Cancer Prostatic Dis. 2021;24(4):1129-1136. doi:10.1038/s41391-021-00370-z
23. Tomic K, Ventimiglia E, Robinson D, Häggström C, Lambe M, Stattin P. Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population-based study. Int J Cancer. 2018;142(12):2478-2484. doi:10.1002/ijc.31272
24. Weprin SA, Parker DC, Jones JD, et al. Association of Low Socioeconomic Status With Adverse Prostate Cancer Pathology Among African American Men Who Underwent Radical Prostatectomy. Clin Genitourin Cancer. 2019;17(5):e1054-e1059. doi:10.1016/j.clgc.2019.06.006
25. Pollack CE, Armstrong KA, Mitra N, et al. A multidimensional view of racial differences in access to prostate cancer care. Cancer. 2017;123(22):4449-4457. doi:10.1002/cncr.30894
26. Lojanapiwat B, Anutrakulchai W, Chongruksut W, Udomphot C. Correlation and diagnostic performance of the prostate-specific antigen level with the diagnosis, aggressiveness, and bone metastasis of prostate cancer in clinical practice. Prostate Int. 2014;2(3):133-139. doi:10.12954/pi.14054
27. Chinea FM, Lyapichev K, Epstein JI, et al. Understanding PSA and its derivatives in prediction of tumor volume: addressing health disparities in prostate cancer risk stratification. Oncotarget. 2017;8(13):20802-20812. doi:10.18632/oncotarget.14903
28. Hoge C, Verma S, Lama DJ, et al. Racial disparity in the utilization of multiparametric MRI–ultrasound fusion biopsy for the detection of prostate cancer. Prostate Cancer Prostatic Dis. 2020;23(4):567-572. doi:10.1038/s41391-020-0223-5
29. Prostate with Watchful Waiting Database - SEER Data & Software. SEER. Accessed July 27, 2022. https://seer.cancer.gov/seerstat/databases/prostate-ww/index.html
30. Moses KA, Orom H, Brasel A, Gaddy J, Underwood W III. Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter? Urology. 2017;99:76-83. doi:10.1016/j.urology.2016.07.045
31. Schmid M, Meyer CP, Reznor G, et al. Racial differences in the surgical care of Medicare beneficiaries with localized prostate cancer. JAMA Oncol. 2016;2(1):85-93. doi:10.1001/jamaoncol.2015.3384
32. Wenzel M, Nocera L, Collà Ruvolo C, et al. Racial/Ethnic Disparities in Tumor Characteristics and Treatments in Favorable and Unfavorable Intermediate Risk Prostate Cancer. J Urol. 2021;206(1):69-79. doi:10.1097/ju.0000000000001695
33. des Bordes JKA, Lopez DS, Swartz MD, Volk RJ. Sociodemographic Disparities in Cure-Intended Treatment in Localized Prostate Cancer. J Racial Ethn Health Disparities. 2018;5(1):104-110. doi:10.1007/s40615-017-0348-y
34. Krishna S, Fan Y, Jarosek S, Adejoro O, Chamie K, Konety B. Racial Disparities in Active Surveillance for Prostate Cancer. J Urol. 2017;197(2):342-349. doi:10.1016/j.juro.2016.08.104
35. Mahal BA, Butler S, Franco I, et al. Use of Active Surveillance or Watchful Waiting for Low-Risk Prostate Cancer and Management Trends Across Risk Groups in the United States, 2010-2015. JAMA. 2019;321(7):704-706. doi:10.1001/jama.2018.19941
36. Wang EH, Yu JB, Abouassally R, et al. Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort. Urology. 2016;95:88-94. doi:10.1016/j.urology.2016.06.010
37. Asiri IM, Chen RC, Young HN, et al. Race and prostate specific antigen surveillance testing and monitoring 5-years after definitive therapy for localized prostate cancer. Prostate Cancer Prostatic Dis. 2021;24(4):1093-1102. doi:10.1038/s41391-021-00365-w
38. Spencer BA, Insel BJ, Hershman DL, Benson MC, Neugut AI. Racial disparities in the use of palliative therapy for ureteral obstruction among elderly patients with advanced prostate cancer. Support Care Cancer. 2013;21(5):1303-1311. doi:10.1007/s00520-012-1666-6
39. Abdollah F, Sammon JD, Majumder K, et al. Racial Disparities in End-of-Life Care Among Patients With Prostate Cancer: A Population-Based Study. J Natl Compr Canc Netw. 2015;13(9):1131-1138. doi:10.6004/jnccn.2015.0138
40. Vince RA Jr, Jamieson S, Mahal B, Underwood W III. Examining the Racial Disparities in Prostate Cancer. Urology. 2022;163:107-111. doi:10.1016/j.urology.2021.08.004
41. Faisal FA, Sundi D, Cooper JL, et al. Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up. Urology. 2014;84(6):1434-1441. doi:10.1016/j.urology.2014.08.039
42. Sundi D, Ross AE, Humphreys EB, et al. African American Men With Very Low–Risk Prostate Cancer Exhibit Adverse Oncologic Outcomes After Radical Prostatectomy: Should Active Surveillance Still Be an Option for Them? J Clin Oncol. 2013;31(24):2991-2997. doi:10.1200/jco.2012.47.0302
43. Maurice MJ, Sundi D, Schaeffer EM, Abouassaly R. Risk of Pathological Upgrading and Up Staging among Men with Low Risk Prostate Cancer Varies by Race: Results from the National Cancer Database. J Urol. 2017;197(3 Part 1):627-631. doi:10.1016/j.juro.2016.08.095
44. Mahal BA, Aizer AA, Ziehr DR, et al. Racial Disparities in Prostate Cancer–Specific Mortality in Men With Low-Risk Prostate Cancer. Clin Genitourin Cancer. 2014;12(5):e189-e195. doi:10.1016/j.clgc.2014.04.003
45. Fernando A. Mental Health and Cancer: Why It Is Time to Innovate and Integrate—A Call to Action - ClinicalKey. Elsevier ClinicalKey. Published June 30, 2020. Accessed July 25, 2022. https://www-clinicalkey-com.proxy.pnwu.org/#!/content/playContent/1-s2.0-S2405456920301917?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2405456920301917%3Fshowall%3Dtrue&referrer=
46. Ilie G, Rutledge R, Sweeney E. An Examination of the Role of Socioeconomic Status in the Relationship between Depression and Prostate Cancer Survivorship in a Population-Based Sample of Men from Atlantic Canada. Oncology. 2021;99(4):260-270. doi:10.1159/000512444
47. Watts S, Leydon G, Birch B, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901. doi:10.1136/bmjopen-2013-003901
48. van Stam MA, van der Poel HG, Bosch JLHR, et al. Prevalence and correlates of mental health problems in prostate cancer survivors: A case-control study comparing survivors with general population peers. Urol Oncol. 2017;35(8):531.e1-531.e7. doi:10.1016/j.urolonc.2017.03.028
49. Heo J, Noh OK, Chun M, Oh Y, Kim L. Psychological distress among prostate cancer survivors in South Korea: A nationwide population‐based, longitudinal study. Asia‐Pac J Clin Oncol. 2020;16(2):e125-e130. doi:10.1111/ajco.13160
50. Bradley C, Ilie G, MacDonald C, Massoeurs L, Vo JDCT, Rutledge RDH. Treatment Regret, Mental and Physical Health Indicators of Psychosocial Well-Being among Prostate Cancer Survivors. Curr Oncol. 2021;28(5):3900-3917. doi:10.3390/curroncol28050333
51. Huang CY, Wang MJ, Lin YH, Chen CI. Depressive Symptoms and Health-Related Quality of Life Among Prostate Cancer Survivors. Cancer Nurs. 2018;41(1):E1-E8. doi:10.1097/ncc.0000000000000420
52. Watson E, Shinkins B, Frith E, et al. Symptoms, unmet needs, psychological well-being and health status in survivors of prostate cancer: implications for redesigning follow-up. BJU Int. 2015;117(6B):E10-E19. doi:10.1111/bju.13122
53. DeWitt-Foy ME, Gam K, Modlin C, Kim SP, Abouassaly R. Race, Decisional Regret and Prostate Cancer Beliefs: Identifying Targets to Reduce Racial Disparities in Prostate Cancer. J Urol. 2021;205(2):426-433. doi:10.1097/ju0000000000001385
54. Odeo S, Degu A. Factors affecting health-related quality of life among prostate cancer patients: A systematic review. J Oncol Pharm Pract. 2020;26(8):1997-2010. doi:10.1177/1078155220959414
55. Matthews AK, Tejeda S, Johnson TP, Berbaum ML, Manfredi C. Correlates of Quality of Life among African American and White Cancer Survivors. Cancer Nurs. 2012;35(5):355-364. doi:10.1097/ncc.0b013e31824131d9
56. Erim DO, Bennett AV, Gaynes BN, Basak RS, Usinger D, Chen RC. Associations between prostate cancer‐related anxiety and health‐related quality of life. Cancer Med. 2020;9(12):4467-4473. doi:10.1002/cam4.3069
57. Bates AJ, Rosser BRS, Polter EJ, et al. Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors. Front Oncol. 2022;12. doi:10.3389/fonc.2022.833197
58. Gordon JR, Baik SH, Schwartz KTG, Wells KJ. Comparing the Mental Health of Sexual Minority and Heterosexual Cancer Survivors: A Systematic Review. LGBT Health. 2019;6(6):271-288. doi:10.1089/lgbt.2018.0204
59. Aarts MJ, Mols F, Thong MSY, Louwman MW, Coebergh JWW, van de Poll-Franse LV. Long-term prostate cancer survivors with low socioeconomic status reported worse mental health-related quality of life in a population-based study. Urology. 2010;76(5):1224-1230. doi:10.1016/j.urology.2010.06.013
60. Krupski TL, Fink A, Kwan L, et al. Health-Related Quality-of-Life in Low-Income, Uninsured Men with Prostate Cancer. J Health Care Poor Underserved. 2005;16(2):375-390. doi:10.1353/hpu.2005.0037
61. Bouchard LC, Yanez B, Dahn JR, et al. Brief report of a tablet-delivered psychosocial intervention for men with advanced prostate cancer: Acceptability and efficacy by race. Transl Behav Med. 2018;9(4):629-637. doi:10.1093/tbm/iby089
62. Erim DO, Bensen JT, Mohler JL, et al. Prevalence and Predictors of Probable Depression in Prostate Cancer Survivors. Cancer. 2019;125(19):3418-3427. doi:10.1002/cncr.32338
63. Purushotham A, Bains S, Lewison G, Szmukler G, Sullivan R. Cancer and mental health—a clinical and research unmet need. Ann Oncol. 2013;24(9):2274-2278. doi:10.1093/annonc/mdt214
64. Chen WC, Boreta L, Braunstein SE, et al. Association of mental health diagnosis with race and all‐cause mortality after a cancer diagnosis: Large‐scale analysis of electronic health record data. Cancer. 2022;128(2):344-352. doi:10.1002/cncr.33903
65. Luckenbaugh AN, Wallis CJD, Huang LC, et al. Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes. J Urol. 2022;207(5):1029-1037. doi:10.1097/ju.0000000000002370
66. Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS. Spirituality influences health related quality of life in men with prostate cancer. Psychooncology. 2006;15(2):121-131. doi:10.1002/pon.929
67. Bellardita L, Rancati T, Alvisi MF, et al. Predictors of health-related quality of life and adjustment to prostate cancer during active surveillance. Eur Urol. 2013;64(1):30-36. doi:10.1016/j.eururo.2013.01.009
68. Ernst M, Wiltink J, Tibubos AN, et al. Linking cancer and mental health in men and women in a representative community sample. J Psychosom Res. 2019;124:109760. doi:10.1016/j.jpsychores.2019.109760
69. Zhang AY, Gary F, Zhu H. Attitudes Toward Cancer and Implications for Mental Health Outcome in African-American Cancer Patients. J Canc Educ. 2015;30(1):138-144. doi:10.1007/s13187-014-0704-0
70. Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer. BMJ Open. 2019;9(1):e026809. doi:10.1136/bmjopen-2018-026809
71. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012;2012(8):CD008465. doi:10.1002/14651858.cd008465.pub2
72. Rice SM, Kealy D, Ogrodniczuk JS, et al. The Anxiety Depression Pathway Among Men Following a Prostate Cancer Diagnosis: Cross-Sectional Interactions Between Anger Responses and Loneliness. Am J Mens Health. 2021;15(3):15579883211023700. doi:10.1177/15579883211023699
73. Gerhart J, Schmidt E, Lillis T, O’Mahony S, Duberstein P, Hoerger M. Anger Proneness and Prognostic Pessimism in Men With Prostate Cancer. Am J Hosp Palliat Care. 2017;34(6):497-504. doi:10.1177/1049909116636358
74. Degan TJ, Kelly PJ, Robinson LD, et al. Health literacy in people living with mental illness: A latent profile analysis. Psychiatry Res. 2019;280:112499. doi:10.1016/j.psychres.2019.112499
75. Goodwin BC, March S, Zajdlewicz L, Osborne RH, Dunn J, Chambers SK. Health literacy and the health status of men with prostate cancer. Psychooncology. 2018;27(10):2374-2381. doi:10.1002/pon.4834