Clinical presentation and initial management of Black men and White men with prostate cancer in the United Kingdom: the PROCESS cohort study

Evans, Simon; Metcalfe, Chris; Patel, Biral; Ibrahim, Fowzia; Anson, Ken; Chinegwundoh, Frank; Corbishley, Cathy; Gillatt, David; Kirby, RS; Muir, Gordon; Nargund, Vinod; Popert, Rick; Wilson, Peter; Persad, Raj; Ben-Shlomo, Yoav

doi:10.1038/sj.bjc.6605461

Cited by 30 publications

(29 citation statements)

References 16 publications

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“…This evidence is consistent with reports of comparable biological disease characteristics in blacks and whites. 23,24 Our results also support the premise that differences in outcomes based on race are reduced or eliminated when patients have access to similar opportunities for treatment. Thus, race may be a marker for other prognostic factors.…”

Section: Discussionsupporting

confidence: 77%

‘Race’ and Prostate Cancer Mortality in Equal-access Healthcare Systems

Graham-Steed

Uchio

Wells

et al. 2013

The American Journal of Medicine

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BACKGROUND Reports suggest worse health-related outcomes among black (vs white) men diagnosed with prostate cancer, but appropriate cause–effect inferences are complicated by the relationship of race and other prognostic factors. METHODS We searched the literature to find contemporary articles focusing on mortality among black and white men with prostate cancer in equal-access healthcare systems. We also directly assessed the association of race and prostate cancer mortality by conducting an observational cohort analysis of 1270 veterans diagnosed with prostate cancer and followed for 11 to 16 years at 9 medical centers within the Veterans Health Administration. RESULTS Among 5 reports providing quantitative results for the association of race and mortality among men with prostate cancer in equal-access systems, outcomes were similar for black and white men. Race also was not a prognostic factor in the observational cohort analysis of US veterans, with an adjusted hazard ratio for black (vs white) men and prostate cancer mortality of 0.90 (95% confidence interval, 0.58–1.40; P = .65). CONCLUSIONS Mortality among black and white patients with prostate cancer is similar in equal-access healthcare systems. Studies that find racial differences in mortality (including cause-specific mortality) among men with prostate cancer may not account fully for socioeconomic and clinical factors.

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Section: Discussionsupporting

confidence: 77%

‘Race’ and Prostate Cancer Mortality in Equal-access Healthcare Systems

Graham-Steed

Uchio

Wells

et al. 2013

The American Journal of Medicine

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“…The authors concluded that prostate cancer grows more rapidly and/or shows early transformation from latent to aggressive disease in African-American men compared with white men. This observation is consistent with studies from the UK, France, and South Africa, which all reported that black men presented with prostate cancer at a younger age than white men [28][29][30] .…”

supporting

confidence: 93%

Prostate cancer in men of African origin

2015

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Men of African origin are disproportionately affected by prostate cancer: prostate cancer incidence is highest among men of African origin in the USA, prostate cancer mortality is highest among men of African origin in the Caribbean, and tumour stage and grade at diagnosis are highest among men in sub-Saharan Africa. Socioeconomic, educational, cultural, and genetic factors, as well as variations in care delivery and treatment selection, contribute to this cancer disparity. Emerging data on single-nucleotide-polymorphism patterns, epigenetic changes, and variations in fusion-gene products among men of African origin add to the understanding of genetic differences underlying this disease. On the diagnosis of prostate cancer, when all treatment options are available, men of African origin are more likely to choose radiation therapy or to receive no definitive treatment than white men. Among men of African origin undergoing surgery, increased rates of biochemical recurrence have been identified. Understanding differences in the cancer-survivorship experience and quality-of-life outcomes among men of African origin are critical to appropriately counsel patients and improve cultural sensitivity. Efforts to curtail prostate cancer screening will likely affect men of African origin disproportionately and widen the racial disparity of disease.

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“…5 These population-based observations indicate that although SES and access to therapy undoubtedly explain some of the racial disparities in prostate cancer prognosis, there may be important tumor characteristics that differ in white and African American patients with prostate cancer. These findings are not limited to the United States and were confirmed in other countries including Great Britain, 6,7 France, 8 and Brazil. 9 However, it is also important to keep in mind that a large hospital-based cohort study in the United Kingdom found that after fully controlling for treatment and stage, race was no longer a predictor of survival or treatment outcomes.…”

supporting

confidence: 67%