A recent study published in JAMA Network Open looked at the genetic differences in prostate cancer between races. Researchers used data from over 5,000 military veterans with metastatic disease (meaning the cancer has spread from its original site) who underwent next-generation sequencing (NGS) to analyze their DNA through the Department of Veterans Affairs National Precision Oncology Program between 2019 and 2023. While the study suggests that genomic testing could help guide treatment for Black men with prostate cancer, medical experts say the study is missing the mark and not addressing the root of this long-standing health disparity.
The researchers of the JAMA study looked at 10 of the most commonly altered tumor genes in non-Hispanic Black and White men with metastatic prostate cancer. They discovered that nine of the ten genes were the same across racial groups, but noted that one gene, TP53, appeared more frequently in Black men and was associated with worse survival outcomes.
According to the study’s authors, this supports the value of genomic testing “irrespective of race or ethnicity,” suggesting that it could help create more equitable health outcomes in prostate cancer treatment.
But not everyone agrees with the study’s findings. “Nine out of ten of the most commonly altered genes were the same in Black and White men, but they focused on the one gene,” says Mack Roach III, MD, FACR, FASTRO, FASCO, Professor of Radiation Oncology and Urology and Director of the Particle Therapy Research Program & Outreach at UCSF. “They don’t show that genetic alteration is related to race.”
The study reported that the presence of TP53 mutations was linked to survival across all racial groups—not just Black men. The hazard ratios—a measure of risk—were nearly identical: 1.54 for one group, 1.52 for another.
And while the study does highlight genetic differences, it doesn’t explain why Black men are more likely to develop prostate cancer or die from it in the first place than other racial groups, leaving a significant gap in findings.
“Although there were differences in the genes, those genes don’t appear to be related in any way to differences reported in survival,” Dr. Roach says. “The study doesn’t show prostate cancer is more common in Black men, and it doesn’t explain the excess mortality rate.”
Several studies, including a research review led by Dr. Roach, reveal that when care is equal across the board, Black men have prostate cancer outcomes that are equal to—and sometimes better than—those of White men. “There is no inherent biologically more aggressive prostate cancer in Black men,” Dr. Roach says.
That suggests the real issue is not biology, but factors like delayed diagnosis, lack of insurance, and unequal treatment, which can all disproportionately affect Black patients. Unfortunately, many studies like this one can overlook these systemic issues when searching for answers.
Many socioeconomic and structural factors prevent Black Americans from getting the healthcare they deserve, leading to the health disparities that we still see today. While studies like these may seem like they’re uncovering significant genetic differences, they’re not getting to the real root cause: unequal access to high-quality care.
According to Dr. Roach, focusing on one genetic difference doesn’t really explain why Black men are more likely to die from prostate cancer—it’s about systemic inequities, not biology.
While the authors of this study likely had good intentions, it’s just one small piece of a much larger puzzle. To close the racial gap in prostate cancer outcomes, researchers and healthcare providers need to focus on the deeper issues, such as access, trust, and accountability in care, rather than just genetics.
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