Disparities in prostate cancer incidence and mortality rates: Solvable or not?

Abstract

Prostate cancer (PCa) is recognized as a disease possessing not only great variation in its geographic and racial distribution but also tremendous variation in its potential to cause morbidity and death and it, therefore, ought not to be considered a homogenous disease entity. Morbidity and death from PCa are disproportionately higher in men of African ancestry (MAA) who are generally observed to have more aggressive disease and worse outcomes following treatment compared to men of European ancestry (MEA). The higher rates of PCa among MAA relative to MEA appear to be multifactorial and related to inherent differences in biological aggressiveness; a continued lack of awareness of the disease and methods of prevention; a lower prevalence of screen‐detected PCa; comparatively lower access to quality healthcare as well as systemic and institutionalized disparities in the administration of optimal care to MAA in developed countries such as the United States of America where high‐quality care is available. Even when access to quality healthcare is assured in equal access settings, it appears that MAA still have worse outcomes after PCa treatment stage‐for‐stage and grade‐for‐grade compared to MEA, suggesting that, inherent racial, ethnic and biological differences are paramount in predicting poor outcomes. This review has explored the different contributing factors to the current disparities in PCa incidence and mortality rates with emphasis on the incongruence in how research has been conducted in understanding the disease towards developing therapies.

COVID-19 and Cancer: Current Challenges and Perspectives

“…In particular, in the United States and in the United Kingdom, race and ethnicity have appeared to be important correlates of rates of infection and of adverse outcomes in patients with COVID-19 in general (Chowkwanyun and Reed, 2020;Williamson et al, 2020;Yancy, 2020). This result mirrors the relationship previously observed between adverse outcomes in other diseases, including cancer, and race and ethnicity (Badal et al, 2020;Marinac et al, 2020;Marinaro et al, 2020;Yedjou et al, 2019). These health disparities are thought to be largely driven by socioeconomic status, lack of sufficient access to care, and area of residence, but biological factors have been implicated in certain instances (although not with COVID-19).…”

Outcomes of Black men with prostate cancer treated with radiation therapy in the Veterans Health Administration

“…Overall, Black men are 1.8 times more likely to be diagnosed with prostate cancer compared with White men. In addition, Black individuals have a significantly higher lifetime risk of death from prostate cancer, with a 4.4% risk of death compared with 2.4% in White men 1,2 . Black men are diagnosed with prostate cancer at an earlier age and often present with higher grade and stage at diagnosis 3 .…”

“…Determining the intrinsic impact of race on outcomes for patients with prostate cancer is complex 2 . There is an interplay between a multitude of possible determinants, including socioeconomic, ancestral, biologic, and cultural mediators 2 .…”

Immortalization of human primary prostate epithelial cells via CRISPR inactivation of the CDKN2A locus and expression of telomerase

“…Therefore, this methodology could also be used to immortalize patient-derived prostate cancer cells from patients with diverse genetic ancestry, which is a major limitation of the existing PCa cell line collection. Such cell lines could potentially serve as cellular models to help address PCa disparities [31,32].…”