Geographic and outcome variation among black men diagnosed with prostate cancer

Abstract

BackgroundProstate cancer is the sixth leading cause of death from cancer among men worldwide. We have previously reported that prostate cancer survival rates for Caribbean-born males in the US was similar to survival rates of African-Americans and was higher than their counterparts diagnosed in the Caribbean. However, it is not clear whether differences in mortality could be attributed to differences in treatment.MethodsThis current analysis seeks to further explore reasons for the geographic variation of prostate cancer survival for Caribbean-born men. This analysis included 2,554 Black newly diagnosed prostate cancer cases (960 cases diagnosed in the US and 1,594 cases diagnosed in the Caribbean). Clinical data were extracted from the cancer registry and clinical charts.ResultsThere were noted differences in the pattern of treatment for each place of birth category when stratified according to disease stage at diagnosis. Among the patients diagnosed with early-intermediate disease (stage I-III) the majority of US-born Brooklyn men were treated with surgery only (31%) and a similar pattern was observed for Caribbean-born Brooklyn men (35%). In contrast, the majority of Caribbean-born Trinidad & Tobago men were treated with hormone therapy (31%).Caribbean-born men diagnosed in the Caribbean had a significantly higher risk of death from prostate cancer (Adjusted Hazard [AdjHR]: 3.7, 95% Confidence Interval [CI]: 2.8-5.0) when compared with the risk of death for Caribbean-born males diagnosed in the US. This observation was consistent for each treatment group with the exception of the cases treated with hormone therapy only. For these cases, there was no difference in the risk of death between Caribbean-born males diagnosed in the Caribbean (AdjHR: 1.4, 95% CI: 0.8-2.6) compared to Caribbean-born males diagnosed in the US.ConclusionsIn addition to difference in access and utilization of screening, differences in treatment strategy may also be a strong predictor of outcome for Caribbean-born males diagnosed with prostate cancer. Further studies are needed to confirm these findings. In addition, other environmental factors related to survival that was not considered in this analysis also need to be investigated.

Black Is Diverse: The Untapped Beauty and Benefit of Cancer Genomics and Precision Medicine

“…30 Among patients with prostate cancer, Afro-Caribbean immigrant men have similar survival rates from prostate cancer compared with AA men. 29 By contrast, Afro-Caribbean immigrant women diagnosed with breast and endometrial cancer are associated with better overall survival than US-born Black women. 31,32 Reasons for this are confounded by socioeconomic status and access to care, but also biology.…”

“…[21][22][23][24] African ancestry and place of birth have been shown to have differential advantages in men and women diagnosed with cancer. Studies demonstrate distinct differences between CBB or ABB and UBB in cancer mortality rates, 22,23 survival, 21,[25][26][27][28][29] and in underlying social determinants of these outcomes, for example, cancer fatalism. 30 Among patients with prostate cancer, Afro-Caribbean immigrant men have similar survival rates from prostate cancer compared with AA men.…”

Beliefs that contribute to delays in diagnosis of prostate cancer among Afro‐Caribbean men in Trinidad and Tobago

“…Prostate cancer (PCa) is the most common cancer and leading cause of death among Afro‐Caribbean men in TT . Reports from the National Cancer Registry have shown that men present late with symptoms and are frequently diagnosed with advanced PCa . Some reasons for being diagnosed with advanced PCa were lack of PCa screening programmes, low screening uptake, and inadequate cancer care services .…”

“…Reports from the National Cancer Registry have shown that men present late with symptoms and are frequently diagnosed with advanced PCa . Some reasons for being diagnosed with advanced PCa were lack of PCa screening programmes, low screening uptake, and inadequate cancer care services . There is a dearth of explorative research surrounding TT men's PCa prediagnosis experiences.…”

Herbal remedies and functional foods used by cancer patients attending specialty oncology clinics in Trinidad

“…The major ethnic groups on the islands are African and Asian Indian descendants with disproportionately higher incidences of prostate and breast cancers among African-Trinidadians [ 2 ], with poorer prognosis compared with their Asian Indian counterparts [ 3 , 4 ]. It has also been shown that African-Caribbean men with prostate cancer living in the Caribbean had a 3.7-fold increased risk of death compared with their African-Caribbean born counterpart living the United States [ 5 ]. Similarly, African-Caribbean women with breast cancer had poorer prognosis than their African-American counterparts [ 6 ].…”