Breaking Barriers in Prostate Cancer Care: The Hidden Impact of Research Gaps

Dr. Nicole Rochester:

We know that access barriers to cancer care exist across solid tumors, whether we’re talking about breast, colorectal, bladder, or prostate cancer. But many of these barriers are unique to specific diseases and the populations they disproportionately affect. For prostate cancer, which affects Black men at significantly higher rates, these barriers to care can be particularly complex.

So, Dr. Burnham, your research reveals that even our foundational research tools don’t represent diverse populations. Can you tell us how these upstream research gaps translate into downstream practice barriers? Like delayed adoption of therapies or limited guideline awareness, particularly in community oncology settings serving marginalized populations?

Dr. Leanne Woods-Burnham:

Yes, definitely. So, when we’re talking about the ability of research tools to represent diverse populations, we have to start with the facts that prostate cancer is driven, aggressiveness is driven by so many different factors, right? So, some of these factors are biological, and we know that there are genetic variants that are likely to lead certain populations to have more aggressive prostate cancer.

So when we’re talking about in the U.S., the highest risk population being men of West African ancestry, you really want to keep this in mind as you’re developing research tools and experimental models that are going to be inclusive. And so, part of that is recognizing that at the very beginning of the science, when you’re designing your experiments, when you’re designing your research studies and your clinical trials, that you make sure that you have biospecimens that are representative of all populations.

You want to make sure that whether you’re using cancer cell lines in the lab, that you have cancer cell lines that come from men of different disease stages of prostate cancer, different ancestral backgrounds included in that. Also, when you’re working with animal models or PDX models, and you’re receiving xenograph derived from patients that have various backgrounds, you want to make sure that men that are at worst risk for worse outcomes that those tissue samples are represented.

And so, a lot of times, unfortunately, what we notice is that these experimental designs don’t always include varied ancestral backgrounds in the design. But for those of us who do like to include them in the experimental design, some of these resources are limited for us, and so it’s really exciting for researchers today who are actively trying to expand diverse biospecimens that are available to scientists to be able to improve what we’re looking at at an earlier onset of the process, at the scientific process.

Because what we know is then when you’re then talking about drug development and designing therapeutics that we know can work well in all populations. What history has shown us is when we don’t take into account people of different backgrounds and how their ancestry can affect their treatment response, then sometimes we don’t see a uniform treatment response. So we see this whether we’re looking at blood thinner medications for Black people versus other people. We know this, in terms of some lung cancer treatments and how people of Asian ancestry respond different than people of other genetic ancestry. Those are just a few examples, but the reason it’s so important to start at the bench at being inclusive is because then that translates into our drug discovery.

And then as we go down, like, down the line, as we talk about clinical trial enrollment, and then standard of care treatment options in the clinic, of course, it’s always important to think about that as well. But the last point I want to make in response to this topic is it’s so important when you’re looking at the pipeline of the medical student to the resident, to the physician, to the postdoctoral fellow, to the academic faculty member who is designing some of these studies.

It’s important when you’re looking at a pipeline, is what we know, what studies have shown us, and what I know from personal experience, is that when you have family members who are affected, or when you come from a community that sees worse outcomes of disease more frequently than maybe some other communities, you have a personal drive, in addition to your academic prowess, but you have a personal drive to give back and to reach back, and a lot of people do that.

And so, that’s, to me, why the pipeline is so important, because if you have a pipeline that is representative of all populations, then when we go and get our MDs and our PhDs and our JDs and all of the degrees to help to progress health outcomes, then you have more of a fuller picture sitting at the table, at the decision-making tables, to help move the needle forward.

Dr. Nicole Rochester:

Thank you so much, Dr. Burnham. I feel like you just took us through such a great progression of how these upstream challenges lead to the downstream outcomes and the disparities and the inequities that we see clinically. So thank you so much for sharing that.