Racial disparities in prostate cancer: A complex interplay between socioeconomic inequities and genomics

Lowder, Dallin; Rizwan, Kinza; McColl, Collin; Paparella, Alyssa; Ittmann, Michael; Mitsiades, Nicholas; Kaochar, Salma

doi:10.1016/j.canlet.2022.01.028

Cited by 36 publications

(35 citation statements)

References 111 publications

(116 reference statements)

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“…Additionally, DNA repair genes and androgen receptors (AR) have been differentially expressed in Black men with prostate cancer. 16,25 While race is a social construct and not a biological variable and the present investigation did not directly evaluate genetic contributions to prostate cancer, the findings from this study may indirectly support a hypothesis of genetic variations for the noted disparities. Consistent with other studies, Black men in this investigation were diagnosed at a significantly younger age than White men.…”

Section: Dovepressmentioning

confidence: 54%

“… 24 Differences in (epi)genetic alterations, immune system function, comorbidities and therapeutic resistance across races suggest an underlying biological mechanism that may help to partially explain the sub-optimal prostate cancer outcomes in the former group. 16 In the largest genome wide association study of prostate cancer to date, Conti et al reported that among 107,247 cases and 127,006 controls, genetic risk was more than twice as high in Black men compared to their White counterparts. 24 The authors further state that this finding was not commonly observed with other types of cancer, thus suggesting strong heritability for this disease.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, DNA repair genes and androgen receptors (AR) have been differentially expressed in Black men with prostate cancer. 16 , 25 …”

Section: Discussionmentioning

confidence: 99%

“…The increased burden of prostate cancer among Black men compared to other groups is likely the result of a complex multifactorial interplay of social determinants, economic and lifestyle factors, environmental exposures and genetic contributors. [14][15][16] Several retrospective studies utilizing the Veterans Affairs (VA) database evaluated whether a medical system which provides equal access to care would result in reduced racial disparities for prostate cancer. [5][6][7][8] In one such investigation which included more than 60,000 veterans diagnosed with the disease, survival rates in Black men were found to be similar to those in White men.…”

Section: Dovepressmentioning

confidence: 99%

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Racial Disparities in Prostate Cancer Stage at Diagnosis Persist Despite Community Affluence

Nemesure¹,

Scarbrough²,

Mermelstein³

2022

RRU

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Purpose The aims of this investigation were to evaluate racial disparities in prostate cancer among men living in a relatively affluent community with access to high quality healthcare. Patients and Methods This retrospective study included 1363 cases with prostate cancer entered into the Stony Brook Cancer Center registry between 2010 and 2020. Demographic and other factors, including the Distressed Community Index (DCI) which provides an indicator of socioeconomic status by zip code, were analyzed as predictors of later stage disease using logistic regression. Results Approximately 60% of cases resided in a “prosperous” zip code (DCI<20) with median (range) DCI of 16.3 (1.1, 61.8). Black men were diagnosed with later stage disease at a higher rate (p=0.03) and were more likely to be diagnosed at a younger age (p<0.01) compared to White men. However, the distribution of cancer stage stratified by DCI and race did not differ among groups. Black men were 3 times more likely to have Medicaid and a history of diabetes, as well as 33% more likely to have hypertension than White men. Black race (OR=2.08, (1.26, 3.42)), older age (OR=2.56 (1.67, 3.90)) and current smoking (OR=1.61 (1.07, 2.42)) were significant contributors of later stage cancer. Conclusion Black men residing in a relatively affluent suburb were diagnosed at younger ages, later stages, and were more likely to have additional comorbidities compared to White men. This study highlights the complexity of the environmental, societal, and biological contributors to racial disparities that warrants further investigation into the underlying causes for the excess burden on Black men.

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Section: Dovepressmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

“…Additionally, DNA repair genes and androgen receptors (AR) have been differentially expressed in Black men with prostate cancer. 16 , 25 …”

Section: Discussionmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

See 2 more Smart Citations

Racial Disparities in Prostate Cancer Stage at Diagnosis Persist Despite Community Affluence

Nemesure¹,

Scarbrough²,

Mermelstein³

2022

RRU

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“…Still, additional research is needed to fully investigate the biological components of PCa and how they are related to nonbiological ones such as socioeconomic status and stress. 16…”

Section: Introduction Disparities Within Prostate Cancermentioning

confidence: 99%

Racial Disparities and Mental Health Effects Within Prostate Cancer

Conant

Huynh

Chan

et al. 2022

Health Psychology Research

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Disparities in prostate cancer (PCa) exist at all stages: screening, diagnosis, treatment, outcomes, and mortality. Although there are a multitude of complex biological (e.g., genetics, age at diagnosis, PSA levels, Gleason score) and nonbiological (e.g., socioeconomic status, education level, health literacy) factors that contribute to PCa disparities, nonbiological factors may play a more significant role. One understudied aspect influencing PCa patients is mental health related to the quality of life. Overall, PCa patients report poorer mental health than non-PCa patients and have a higher incidence of depression and anxiety. Racial disparities in mental health, specifically in PCa patients, and how poor mental health impacts overall PCa outcomes require further study.

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A Pragmatic Approach to Prostate Cancer Screening

Tosoian,

Penson,

Chinnaiyan

2024

JAMA

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The introduction of prostate-specific antigen (PSA)-based screening for prostate cancer in the early 1990s was followed by a nearly 2-decade long decline in prostate cancer metastasis and mortality. 1 However, clinical trial data revealed that screening was associated with substantial harms. 2 Under the traditional clinical approach in which elevated serum PSA triggered prostate biopsy, roughly 1 in 5 screened men underwent biopsies, with more than 75% found to be negative and a majority of positive biopsies harboring low-grade, clinically insignificant cancers. 3 Prostate biopsies are uncomfortable for patients and carry a risk of bleeding and infection requiring hospitalization. 4 Moreover, during a previous era in which a cancer diagnosis was inexorably linked to treatment, overdiagnosis (ie, detection of indolent cancers that would not have been detected during life in the absence of screening) and overtreatment resulted in significantly reduced quality of life. 5 In 2012, the US Preventive Services Task Force (USPSTF) provided a grade D recommendation against the use of PSA screening, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms. 6 In the time since, longer-term outcomes from highquality studies have better informed the benefits of screening. After 22 years of follow-up in the Gotebörg screening trial, 7 the rate ratio for prostate cancer death in screening participants was 0.59 (95% CI, 0.43-0.80), with a number needed to invite to screening of 221 and number needed to treat of 9 to prevent 1 death from prostate cancer-figures that compare favorably with other common cancers. 8,9 At the same time, a growing understanding of prostate cancer has led to advances to reduce the harms previously associated with screening. For men with favorable-risk cancers, adoption of active surveillance-a management strategy centered on monitoring rather than immediate treatment-has reduced overtreatment and its associated adverse effects. 10 In large part due to these studies quantifying benefit and development of approaches to minimize harms, in 2018 the USPSTF offered an updated grade C recommendation for PSA screening, recommending individualized decision-making in men aged 55-69 years. 11 Current clinical guidelines emphasize a narrowed diagnostic focus on identifying higher-grade cancers, recommending that patients with an elevated PSA level undergo magnetic resonance imaging (MRI), if available, or biomarker testing to better define the risk of high-grade (grade group [GG] ≥2) disease prior to biopsy. 12-14 Indeed, MRI with targeted biopsy improves detection of high-grade cancers relative to stan-Multimedia

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Racial disparities in prostate cancer: A complex interplay between socioeconomic inequities and genomics

Cited by 36 publications

References 111 publications

Racial Disparities in Prostate Cancer Stage at Diagnosis Persist Despite Community Affluence

Racial Disparities in Prostate Cancer Stage at Diagnosis Persist Despite Community Affluence

Racial Disparities and Mental Health Effects Within Prostate Cancer

A Pragmatic Approach to Prostate Cancer Screening

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