Clinical presentation of prostate cancer in Black South Africans

Abstract

BackgroundCompared with White Americans, Black American men are at a significant increased risk of presenting with prostate cancer (PCa) and associated mortality, suggesting a link to African-ancestry. However, PCa status within Africa is largely unknown. We address the clinical presentation of PCa within Black South African men.MethodsOver 1,000 participants with or without PCa have enrolled in the Southern African Prostate Cancer Study (SAPCS). Using genome-wide profiling we establish a unique within Africa population substructure. Adjusting for age, clinical variables were assessed, compared against Black Americans and between rural and urban localities while addressing potential socio-demographic confounders.ResultsWe report a significant difference in the distribution of prostate specific antigen (PSA) levels skewed towards higher PSA levels in the PCa cases (83.0% present with a PSA ≥ 20 µg/L; median PSA = 98.8 µg/L) relative to men with no detectable PCa (18.5% present with a PSA ≥ 20 µg/L; median PSA = 9.1 µg/L). Compared with Black Americans, Black South Africans presented with significantly more aggressive disease defined by Gleason score >7 (17% and 36%, respectively) and PSA ≥ 20 µg/L (17.2% and 83.2%, respectively). We report exasperated disease aggression defined by Gleason score >7 (P = 0.0042) and poorly differentiated tumor grade (P < 0.0001) within rural versus urban localities.ConclusionBlack South African men present with higher PSA levels and histopathological tumor grade compared with Black Americans, which is further escalated in men from rural localities. Our data suggests that lack of PSA testing may be contributing to an aggressive PCa disease phenotype within South African men.

TMPRSS2‐ERG fusions linked to prostate cancer racial health disparities: A focus on Africa

“…Intriguingly, African ancestry is significantly associated with high‐grade (Gleason score ≥ 8) PCa, which questions the role of TMPRSS2‐ERG fusions in tumor development in African populations. Reporting a 2.1‐fold increase in high‐grade PCa presentation in Black South African men compared with African Americans, we sought to determine the frequency, composition, and clinicopathological association of acquired TMPRSS2‐ERG fusions within non‐American men of African ancestry.…”

Whole-Genome Sequencing Reveals Elevated Tumor Mutational Burden and Initiating Driver Mutations in African Men with Treatment-Naïve, High-Risk Prostate Cancer

“…Within Africa, a greater disease burden has been suggested (1,6). The Southern African Prostate Cancer Study (SAPCS) has shown that South African men present with a 2-fold increase in aggressive disease compared with age-adjusted African Americans (7).…”

Proteomic Profiling of Serum-Derived Exosomes from Ethnically Diverse Prostate Cancer Patients

“…The incidence and mortality of the disease is disproportionately high among African American (AA) men compared to other ethnicities in the United States (3). An interesting note is that the disease incidence appears to be lower among Black men in Africa, although this has been attributed to the lack of adequate and sufficient statistics from this region of the world (4). …”