Evidence Supports a Faster Growth Rate and/or Earlier Transformation to Clinically Significant Prostate Cancer in Black Than in White American Men, and Influences Racial Progression and Mortality Disparity

Abstract

Purpose The incidence of prostate cancer is approximately 60% higher and the mortality rate is 2 to 3 times greater in black than in white American men. We propose that a more rapid prostate cancer growth rate and/or earlier transformation from latent to aggressive prostate cancer in black than in white men contribute to this disparity. Materials and Methods We evaluated entirely embedded prostate glands on autopsy from 1,056 black and white men who died of causes other than prostate cancer. We also reviewed data from our radical prostatectomy database and from the Detroit Surveillance, Epidemiology and End Results database. Results Autopsy data indicated that sub-clinical prostate cancer in black and white men starts at early age and clinical characteristics do not differ by race at early ages. Radical prostatectomy specimen data revealed that prostate cancer volume and Gleason grade were greater in black than in white men. Advanced or meta-static prostate cancer occurred at a 4:1 ratio in black and white men, respectively, in the Detroit Surveillance, Epidemiology and End Results registry database. Conclusions Results showed that age at prostate cancer initiation and clinical characteristics did not differ by race in our autopsy series, prostate cancer volume after radical prostatectomy was greater in black than in white men and disease became distant disease at a ratio of 4 black men to 1 white man in the Detroit Surveillance, Epidemiology and End Results population. These findings support the concept that prostate cancer grows more rapidly in black than in white men and/or earlier transformation from latent to aggressive prostate cancer occurs in black than in white men.

Determination of common urine substances as an assay for improving prostate carcinoma diagnostics

“…The current hypothesis is that most aged men have prostate cancer, and they have cells in their prostates that if observed on a needle biopsy would be diagnosed as prostate cancer (58). This fact is supported by the study of Powell et al (59) showing that prostate carcinoma can be found in 50% of males 50 years of age, and 70-80% of men over the age of 70 years, dying from non-prostate cancer-related causes. These lesions are called 'microscopic' or 'latent' foci of prostate cancer, typical of their small size, non-progressiveness, clinically insignificance and rare detection through routine prostate cancer screening.…”

Prostate Cancer Disease Characteristics at the Time of Diagnosis and Initial Treatment Offered in a Tertiary Hospital at Ouagadougou (Burkina Faso)

“…Contrariwise the majority of patients in our study are symptomatic (95.8%) and presented with LUTS and features of locally advanced or metastatic disease. Numerous studies have found that black men have a higher stage of disease at presentation and are more likely to die of their prostate cancer than their white counterparts [15][16][17]. Powell [17] evidenced that African Americans have similar pathogenic mechanisms and age at PCa initiation to Caucasians but they have a faster growth rate and/or an earlier transformation to clinically significant PCa.…”

“…Numerous studies have found that black men have a higher stage of disease at presentation and are more likely to die of their prostate cancer than their white counterparts [15][16][17]. Powell [17] evidenced that African Americans have similar pathogenic mechanisms and age at PCa initiation to Caucasians but they have a faster growth rate and/or an earlier transformation to clinically significant PCa. Late presentation of PCa is commonly reported from SSA [5,[18][19][20].…”

Controversial predictors of biochemical recurrence after radical prostatectomy: a study from a Latin American (Brazilian) Institution

“…Prostate cancer may be biologically more aggressive among Black men though controversial (7)(8)(9). In a study by Cross et al (10), even though African-American men presented at a younger age and with more advanced disease compared with White men with prostate cancer, PSA outcome after RP when controlled for known clinical predictive factors was not statistically different.…”

“…Prostate cancer may be biologically more aggressive among Black men though controversial (7)(8)(9)(10)(11). The prevalence of prostate cancer in Brazil is higher in Black men compared to White men (12)(13)(14)(15).…”