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This Study Shows Who's Missing From Advanced Prostate Cancer Clinical Trials

A recent study in Advanced Urology explored who gets access to clinical trials for advanced prostate cancer in the United States, and older men are among the most affected. These trials are research studies that test new treatments and are crucial for improving patient care. The researchers used data from CancerLinQ Discovery, a large collection of information from many cancer doctors' offices, looking at 17,028 men diagnosed with prostate cancer that had spread either within the surrounding area (regional) or to other parts of the body (metastatic) between 2011 and 2023.

The study showed that very few men with advanced prostate cancer participate in clinical trials. Overall, only 2.6% of patients—just 450 individuals—were enrolled in a trial. The number of participants varied over the years, peaking at almost 4% in 2018 before dropping back down to about 2.4% in 2023. Older men were less likely to join a trial.

The main focus of the study was to see if there were differences in trial participation based on race and ethnicity. Compared to White men, Hispanic/Latino men were significantly less likely to enroll in clinical trials. Men who identified as belonging to another race or ethnicity outside the common categories also had lower chances of participation.

Interestingly, the study found no significant difference in clinical trial enrollment between Black men and White men with prostate cancer. This is important because there are well-documented differences in health outcomes for Black men with prostate cancer.

It's widely known that Black men are more likely to be diagnosed with prostate cancer and are more likely to die from it than White men.

Higher Rates of Diagnosis and Death: Black men have the highest rates of prostate cancer diagnosis in the U.S., about 60% higher than White men. They also have much higher death rates from this disease. For example, for every 100,000 men, roughly 173 Black men are diagnosed with prostate cancer compared to about 108 White men. The death rate is also much higher: about 41 deaths for every 100,000 Black men versus about 19 deaths for every 100,000 White men.

More Aggressive Cancer: Research suggests that prostate cancer in Black men might be more aggressive and is often diagnosed at later stages, which can lead to worse outcomes.

Possible Genetic Factors: Scientists are also looking into whether genetic differences might play a role in why Black men are more likely to develop and die from prostate cancer.

Even though this particular study didn't find a difference in clinical trial enrollment between Black and White men, the fact that Black men face a greater burden from the disease emphasizes the need for them to have equal access to all forms of care, including clinical trials. The study highlights the urgent need to understand why other groups, like Hispanic/Latino men and those who identify as "other race or ethnicity," are less likely to participate and to create solutions to ensure everyone has fair access to these important research studies.

The researchers pointed out some limitations to their study. Because they used data from doctors' offices, there might be other factors they didn't measure that could influence who joins clinical trials. More research is necessary to fully understand why these differences exist and to develop ways to make sure everyone has equal opportunities to participate in clinical trials and receive the best possible care for prostate cancer.

New Study Uncovers Major Link Between Common Herbicides And Prostate Cancer: 'A Tremendous Health Concern'

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A new study by Stanford University researchers found that more than 20 types of pesticides, such as the herbicides 2,4-D and glyphosate — two of the most commonly used in agriculture — may significantly elevate the risk of prostate cancer.

What's happening?

According to The New Lede, researchers studied the link between the amount of pesticides sprayed in counties throughout the United States and prostate cancer rates 14 years after the chemicals were used.

The findings revealed that close to two dozen of these agrochemicals were repeatedly attributed to a higher risk of prostate cancer, which kills about 1 in 44 men, per the American Cancer Society. Not only is it the most prevalent form of cancer in American men, but it's also the second-deadliest, behind only lung cancer.

Glyphosate has been associated with numerous other health problems in humans, including other types of cancers, heart disease, diabetes, kidney disease, and reproductive problems.

The World Health Organization's International Agency for Research on Cancer has classified glyphosate as "probably" carcinogenic and 2,4-D as "possibly" carcinogenic to humans. Furthermore, The New Lede reported that six other chemicals investigated by the research team are considered "potential human carcinogens" by the Environmental Protection Agency.

Even more concerning, three herbicides — cloransulam‐methyl, diflufenzopyr, and trifluralin — and the insecticide thiamethoxam were linked to a higher risk of developing prostate cancer and a greater chance of dying from exposure to them.

Watch now: How bad is a gas stove for your home's indoor air quality? Why are the findings concerning?

Pesticides are ubiquitous in our global food systems, with an estimated 3.85 million tons of the chemicals used on crops worldwide in 2020, according to one study.

Not only do these toxic chemicals pollute the water, air, and soil and damage ecosystems, but they're also increasingly being linked to a plethora of health problems in humans — including prostate cancer. The more pesticides and herbicides we use for our food supply, the greater the risk to people's health and the environment.

Unfortunately, more farmers have been using 2,4-D in recent years as certain plant species have developed a resistance to other herbicides, such as glyphosate, according to The New Lede. Researchers discovered that this herbicide was consistently associated with prostate cancer, which is troubling since it's so frequently used, as Stanford professor of urology and nephrology John Leppert explained.

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He told The New Lede it's a "tremendous health concern" since prostate cancer is so prevalent and can be difficult to treat.

"I think we need to be more aware of considering that what's in the environment could be a contributor to a man's risk of cancer," he added.

What's being done to protect men from prostate cancer?

Fortunately, the insecticide parathion — one of the chemicals most strongly linked to a higher risk of prostate cancer — has been banned in the U.S. And many other countries, signifying a step in the right direction. In addition, Vermont and New York have banned a particularly harmful class of pesticides called neonicotinoids, which will benefit the survival of bees and butterflies and, in turn, protect our food supply.

However, the findings show that more extensive research on how pesticides impact the development and severity of various cancers is "urgently needed," the authors explained.

"Many pesticides have not been sufficiently studied for their potential carcinogenic effects, particularly in relation to prostate cancer," study co-author and Stanford postdoctoral researcher Simon Soerensen told The New Lede.

Meanwhile, we can do our part individually by growing our own food and controlling pests and weeds without chemicals.

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Enhancing Prostate Cancer Detection In Diverse Populations

PROSTATE cancer (PCa) continues to be a significant health concern, particularly given the disparities observed in clinical trial representation. Men of Asian, Black, and Hispanic backgrounds have historically been underrepresented in PCa research, leading to limited validation of novel biomarkers across diverse cohorts. The Stockholm3 risk score, a comprehensive biomarker-based tool, was developed to address these gaps by assessing multiple genetic and clinical parameters. This study aimed to evaluate whether Stockholm3 could enhance prostate cancer detection in diverse populations.

The observational, prospective multicenter trial spanned 17 clinical sites from 2019–2023, supplemented by participants recruited from 2008–2020 in urology clinics. Men with suspected PCa underwent prostate biopsy, and prior to biopsy, blood samples were collected to measure the Stockholm3 risk score. Key parameters included prostate-specific antigen (PSA), free PSA, KLK2, GDF15, PSP94, genetic risk factors (single-nucleotide polymorphisms), age, family history, and previous negative biopsies. The primary endpoint focused on detecting International Society of Urological Pathology (ISUP) Grade ≥2 cancer, considered clinically significant PCa (csPC). The study aimed to demonstrate non-inferior sensitivity using Stockholm3 compared to PSA (noninferiority margin of 0.8 lower bound for the 95% CI), as well as superior specificity by reducing benign and low-grade cancer biopsies.

Results from the 2,129 participants (including Asian, Black, Hispanic, and White men) revealed that Stockholm3 demonstrated non-inferior sensitivity (relative sensitivity: 0.95 [95% CI, 0.92 to 0.99]) compared to PSA ≥4 ng/mL and significantly improved specificity (relative specificity: 2.91 [95% CI, 2.63 to 3.22]). These findings were consistent across racial and ethnic subgroups, with sensitivity ranging from 0.91 to 0.98 and specificity increasing from 2.51 to 4.70. Importantly, the use of Stockholm3 reduced unnecessary biopsies for benign or low-grade cancers by 45% overall, with reductions of 42–52% observed across different racial and ethnic groups.

This study suggests that Stockholm3 demonstrates significant potential to enhance prostate cancer detection in diverse populations while maintaining similar sensitivity to PSA. The reduction in unnecessary biopsies, particularly among Asian, Black, and Hispanic men, highlights the value of incorporating biomarker-based approaches to improve prostate cancer screening and reduce health disparities. Further prospective studies are needed to refine these tools and evaluate their long-term impact on patient outcomes.

Katie Wright, EMJ

Reference

Vigneswaran HT et al. Stockholm3 in a multiethnic cohort for prostate cancer detection (SEPTA): a prospective multicentered trial. J Clin Oncol. 2024;42(32):3806-16.

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