OPINION – In California, an estimated 26,970 men will be diagnosed with prostate cancer. Access to treatment for this deadly disease is most dire among underrepresented communities of color. Fortunately, Assembly Bill (AB) 632 would bridge the gap and help men access cost-free prostate cancer screenings.
Prostate cancer is the most diagnosed cancer and is the second leading cause of cancer death in Californian men. About one in eight men will be diagnosed in their lifetime. Although prostate cancer death rates have stabilized in recent years due to advances in treatment and earlier stage diagnosis with screening, declines in Prostate-Specific Antigen (PSA) testing from 2008 to 2013, most likely caused by misleading information based on obsolete data, have coincided with an uptick in the diagnosis of advanced prostate cancer.
AB 632, authored by Assemblymember Mike Gipson, will allow more men to receive prostate cancer screenings without the worry of excessive healthcare expenses. Although current law requires plans to provide coverage for the screening and diagnosis, men, especially those of low socio-economic status or in underserved populations, have been deterred from accessing testing due to out-of-pocket expenses, such as deductibles, copayments, and coinsurance. As a result, they are not undergoing detection of early-stage prostate cancer. This economic divide is a source of disparity for prostate cancer survival.
A recent study from the American Cancer Society’s (ACS’s) Cancer Facts & Figures 2023 reported, “After about 20 years of declining incidence, the first increase in prostate cancer – especially in late-stage diagnoses – likely results from changes to PSA screening guidelines.” Furthermore, a study from the United States (US) Department of Veterans Affairs reported that African American veterans displaced a nearly two-fold greater incidence of localized and de novo metastatic prostate cancer.
As a clinician who screens, diagnoses, and treats patients with prostate cancer, men should know that screenings are more favorable than they generally believe. In particular, African Americans have a higher rate of prostate cancer deaths and often suffer a more aggressive disease at younger ages. They also have a higher incidence compared to men of other races. Certain risk factors, such as race, family history, genetic predisposition, and military service significantly raise an individual’s risk of developing prostate cancer. For this reason, making the availability of early detection is very important.
This racial disparity in deaths is currently the worst among all cancers in the U.S. We need to consider strategies for creating racial and social parity in prostate cancer through early screen strategies. Additionally, treatment of late-stage prostate cancers impacts quality of life and places an increased economic burden on the health care system, including loss worker productivity and increased financial toxicity for these affected men.
This legislation is even more important during Prostate Cancer Awareness Month. We urge Governor Newsom’s support which will eliminate unnecessary barriers to screenings – a critical first step for diagnosis and a life-saving treatment for Californian men.
John S. Lam is an MD, MBA, FACS and the California Urological Association president