Prostate cancer in men of African origin

Abstract

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.

Prostate Cancer Mortality-To-Incidence Ratios Are Associated with Cancer Care Disparities in 35 Countries

“…These studies indicate that the improvement in the prognosis of prostate cancer was not obvious during these years. However, the high MIR of the African region can be explained by lack of screen, up-staging of disease at the time of diagnosis, the socioeconomic factors, care delivery, and treatment selection that have an African origin8. All of these data support our findings that MIR has a role in prediction of care disparities.…”

“…However, the incidence varied among countries because of differences in the coverage of PSA screenings; the highest number of screenings occurred in Western countries467. In contrast, the incidence of prostate cancer is much lower in Asia and Africa89. Furthermore, the geographic distribution of prostate cancer incidence in Europe shows that the probability of being diagnosed with prostate cancer is closely associated with prior migrations and settlement histories10.…”

Active surveillance for prostate cancer: current evidence and contemporary state of practice

“…African-American (AA) men represented only 7.4% of the Johns Hopkins cohort, and just 13% of the population at the University of California San Francisco was reported as “non-white.” 20,23 Given concerns that AA race is associated with more aggressive cancers 74 , many have questioned whether AA men are appropriate candidates for AS. 75–79 Likely owing to limited sample size, primary manuscripts have not described race-specific outcomes, but several complementary studies have examined the role of race among surveillance-eligible patients.…”

Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer

“…It should be noted that racial, socioeconomic, and age disparities in radiation therapy delivery are well-documented in non-HNC cancers, such as prostate cancer [19]. Based on SEER data, African-American patients were less likely to receive curative-intent therapy (adjusted odds ratio 0.82, 95 % confidence interval 0.79-0.86), especially among patients with NCCN high-risk disease (adjusted odds ratio 0.60, 95 % confidence interval 0.56-0.64) [20].…”