African American Men With Prostate Cancer More Likely to Experience Decisional Regret

African American patients are more likely to experience regret about prostate cancer-related decisions compared with non-African American patients, according to the results of a cohort study now published in the Journal of Urology.

“African American men are more likely to be diagnosed with, die of, and experience decisional regret about their prostate cancer than non-African American men,” write the authors, led by Molly DeWitt-Foy, MD, a urology resident at the Cleveland Clinic. “Although clinical discrepancies may be attributed to genetic risk and/or access to care, explanations for racial discrepancies in decisional regret remain largely speculative. We aim to identify sources of prostate cancer decisional regret with a focus on racial disparities.”

A cohort of 1,112 patients treated at the Cleveland Clinic between 2010 and 2016 were grouped by race, Gleason score, and treatment method, including external beam radiation, brachytherapy, prostatectomy, and active surveillance. The authors also considered prostate specific antigen at diagnosis, age of the patient during treatment, and time elapsed since its end. After providing four surveys, which included the Expanded Prostate Cancer Index Composite (EPIC) 26, the Decisional Regret Scale, the novel Prostate Cancer Beliefs Questionnaire, and a modified EPIC demographics form, the authors implemented descriptive and comparative statistics, along with multivariable logistic regression, to compare the results by race and treatment method.

Using data from 378 returned surveys, Dr. DeWitt-Foy and colleagues found that African American men experienced worse decisional regret compared with non-African American men, even when covariates were adjusted, with an odds ratio of 2.46. African American men also had increased Prostate Cancer Beliefs Questionnaire medical mistrust and masculinity scores of 1.415 and 1.350, respectively, predicting more decisional regret regardless of race.

“African American men suffer worse decisional regret than non-African American men, which may be partially explained by higher medical mistrust and concerns about masculinity as captured by the Prostate Cancer Beliefs Questionnaire,” conclude the authors. “This novel survey may facilitate identifying targets to reduce racial disparities in prostate cancer.”

For More Information

Dewitt-Foy ME, Gam K, Modlin C, et al (2020). Race, decisional regret and prostate cancer beliefs: identifying targets to reduce racial disparities in prostate cancer. J Urol. [Epub ahead of print] DOI:10.1097/JU.0000000000001385

Image credit: Rhoda Baer. Courtesy of the National Cancer Institute.

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