Even with breakthrough treatments available, many patients still struggle to access timely and appropriate prostate cancer care due to structural barriers, insurance denials, prior authorizations, lack of navigation support, and limited awareness of personal risk. In this roundtable segment, Dr. Nicole Rochester, Dr. Stacey Loeb of NYU Langone Health, and Dr. Leanne Woods-Burnham of Morehouse School of Medicine discuss actionable strategies for clinicians to help patients overcome access barriers, strengthen navigation pathways, and close persistent gaps in prostate cancer care, particularly for high-risk and historically underrepresented populations.
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Transcript
Dr. Nicole Rochester:
So, both of you have helped us to understand that testing is a challenge, but even when appropriate therapies exist, patients face real structural barriers, and you’ve talked about some of these. Insurance denials, prior authorization, as well as things like the lack of patient navigators. So, Dr. Loeb, from your population health perspective, what role can providers play in navigating these insurance and access barriers, particularly for underrepresented populations, and what are some things that you’ve seen work?
Dr. Stacey Loeb:
Well, I think patient navigation and social workers can be very helpful and compiling, you know, a set of resources, for example, of options, you know, where to be able to get medications less expensively. There are some apps and programs online that can help with that. So those are just some of the options, and, you know, I think we have to know how well we’re doing in terms of providing care, so I think one of the bedrocks for, you know, implementation is audit and feedback, you know, tracking how well we’re doing with our patients in order to see if there are any disparities or gaps that need to be addressed.
Dr. Nicole Rochester:
Yeah, they say you can’t change what you don’t measure, right? So that’s important. Thank you for lifting that up. Dr. Burnham, anything to add from your community outreach work with the Prostate Cancer Precision Prevention Program?
Dr. Leanne Woods-Burnham:
Yeah, so Dr. Loeb also touched on this briefly previously is, to me, a major barrier I see, which is so surprising, but she’s a thousand percent right, is how much… how many times men who are in high-risk populations do not even know that they are at higher risk. That happens, like, constantly. So that’s a major barrier where you… if you don’t even know that you’re at higher risk, you don’t know when you go into your doctor’s office to advocate for yourself, to find out even if you’re being screened, if you’re having the conversation about the pros and cons of prostate cancer screening.
Because we know, you know, guideline recommendations have fluctuated when it comes to that, but if you’re at a higher risk and you’re going into your doctor’s office, and you’re 45 years old with extensive family history, and your doctor’s saying, you know, you don’t meet the U.S. Preventive Services Task Force recommendation of age 55, so don’t… you’re fine. But you don’t know that you’re at higher risk and you have this family history, then the conversation kind of ends there, because who wants to get extra testing that your doctor’s telling you that you don’t need? Like, none of us want to do that.
So, that’s a major barrier that we see for sure. And what we know, I’ve published previously, is that over half of Black men specifically, this was a study coming out of New York City and also Southern California, over half of them, their doctors were not discussing the pros and cons of prostate cancer screening, so unfortunately, it’s up to the patient sometimes to really be able to advocate for themselves, so we really try to spread awareness so that men know that they can talk about this, that they can find out their own personal risk through a conversation with their physician, and decide if they want to do the PSA blood test or not.