Background: Black men have a two-fold higher rate of prostate cancer death in the United States compared with other men—the largest racial inequity in US cancer-related deaths. With the National Cancer Institute-funded CISNET group, the project team demonstrated that an intensified screening strategy in Black men (i.e., annual prostate-specific antigen (PSA) testing starting at age 45 years) would reduce mortality compared with contemporary screening practices. However, the US Preventive Service Task Force guidelines—which serve as the main national recommendation on screening—do not make screening recommendations specifically for Black men. Furthermore, Black men comprised only 0-3% of two large-scale PSA screening trial cohorts in the United States and Europe, partly due to the clinical research disenfranchisement of Black communities derived from a variety of systemic issues.
Proposed Solution to the Problem: Given the burden of prostate cancer among Black men, capacity must be built to empower Black men and their communities to develop and execute practice-informing clinical trials that may provide guidance for early detection strategies to eliminate inequities in prostate cancer screening and treatment. To understand how to better serve the needs of Black men will require their involvement in all phases of prostate cancer research. The project team hypothesizes that (1) Black men have unique needs around early detection of prostate cancer and (2) community and stakeholder partnership can identify these areas of need and best inform patient-centered design of practice-changing research studies.
Objectives: The objective of this project is to engage a broad coalition of patients, advocates, researchers, clinicians and other key stakeholders around the early detection of prostate cancer among Black men, and to address inequities in prostate cancer outcomes by (1) building engagement and research capacity among a cohort of Black men and researchers/clinicians, (2) identifying research priorities around the early detection of prostate cancer, and (3) developing a research agenda that can inform future large, patient-centered, comparative clinical effectiveness research (CER) trials in early detection of prostate cancer. By building capacity and harnessing the engagement of the community, the project team will move towards the long-term goal of abolishing racial mortality disparities in prostate cancer.
Aim 1: To recruit and train a multi-stakeholder Early Detection Advisory Board (EDAB) of Black men, primary care providers, patient and community advocates, urologists, and researchers to advance patient-centered outcomes research (PCOR) in the early detection of prostate cancer.
Aim 2: To build a Virtual Research Community (VRC) with the capacity to prioritize patient-centered research questions and research study methods to improve the early detection of prostate cancer in Black men.
Aim 3: To develop a research agenda that will support future PCOR/CER to improve the early detection of prostate cancer in Black men.
Projected Outcomes and Outputs:
Short-term outcomes during the project period include: The project team will convene a 15-person EDAB, expanding the Black and African-descent Collaborative for Prostate Cancer Action (BACPAC) to engage a greater breadth of stakeholder perspectives from a nationally representative group of patient advocates, experts, and thought leaders in prostate cancer equity. The goal is to build a multi-stakeholder group that will have the capacity to identify and advance initiatives to address inequities in prostate cancer detection and outcomes.
Working closely with the EDAB, the project team will establish a VRC composed of Black men with a personal or family history of prostate cancer. The VRC will serve as an ongoing network for driving engagement with Black men and will develop community capacity for PCOR/CER that addresses racial inequities in prostate cancer. Working with the EDAB, the project team will develop a research agenda that articulates patient priorities in PCOR/CER and equity-based principles that can guide future prostate cancer PCOR/CER trials. This approach ensures that future research will be responsive to the needs and priorities of those who are the intended end-users of that research, and further serves to remedy the historical exclusion of Black men from prostate cancer research by placing Black men at the center of developing appropriate frameworks and recommendations for future research to address inequities in prostate cancer.
Medium-term outcomes (0-2 years post-project period) include: The VRC will continue to be engaged in the identification and prioritization of research questions and design of future studies across the continuum of prostate cancer care for Black men. Having developed the structure and capacity for partnering in PCOR/CER during the project period, the EDAB and VRC infrastructure will continue to support critical research in prostate cancer equity for Black men. Similarly, the project team anticipates that the research agenda developed during the project period will not only support CER trials in the early detection of prostate cancer, but it will also serve as a roadmap for PCOR/CER across the continuum of prostate cancer care for Black men.
Long-term outcomes (3+ years post-project period) include: By building capacity and harnessing the engagement of the community, the project team will move toward the long-term goal of abolishing racial inequities in prostate cancer. They will continue to engage their partners (i.e., EDAB and VRC members) in developing, assessing, and implementing solutions that address the identified key research priorities to improve the early detection of prostate cancer among Black men and to create equity in both care and outcomes among Black men.
Patient and Stakeholder Engagement Plan: The project team’s approach to stakeholder engagement builds from their experience creating BACPAC, as well as from working with stakeholders as key contributors across a range of other previous and ongoing engagement and research projects.
Project Collaborators: BACPAC is a community of patients, partners, advocates, and researchers in Washington State brought together with the mission of improving prostate cancer care for Black and African-Descent men through community- and patient-centered engagement and research. Additionally, BACPAC has built a broad coalition of 30 community stakeholder organizations in Washington State to facilitate community engagement around prostate cancer equity.