Originally published 6/20/2016
An illuminating paper published Jan. 1, 2022 by Nair, et al. reveals a very important distinction in assessing risk factors among African American prostate cancer (PCa) patients.[i] It’s about the difference between tumor biology and treatment outcomes.
As the original blog below points out, the clinical factors (age, stage, Gleason score, biopsy pathology) are roughly equivalent between non-Hispanic white men and African American men. However, there may be ancestral biologic differences in tumor characteristics (gene expression, DNA repair pathways, metabolic pathways). In other words, it may be that there are inherent differences in cellular activity unique to their ethnicity.
However (and here’s good news), according to the authors, “…epidemiological evidence suggests equal healthcare access ensures equal PCa specific outcomes, implying African–American men’s disease is not inherently more lethal.”
The authors suggest that based on science, specific treatment protocols that address tumor biology might be beneficial, but providing equal access to early detection and excellence in treatment equalizes PCa risk for all patients.
We add that economic and geographic disparities in the availability of multiparametric MRI put those affected at a disadvantage, regardless of their ethnicity, and this is a national men’s health issue.
Almost all statistics point to a greater occurrence of prostate cancer (PCa) among African American men than Caucasian men. According to national data, black men are 1.6 times more likely to be diagnosed with prostate cancer and 2.4 times more likely to die from it. This is thought to be because of a mix of factors that includes socioeconomics, lifestyle and nutritional habits, differences in medical care, and possibly unknown genetic factors. With such sobering demographic patterns, black men with low-risk PCa and their doctors may opt for immediate prostatectomy (RP) rather than Active Surveillance (AS).
However, clinical factors may matter more than population data. I came across a 2015 study that set up a side-by-side comparison of black and white men originally diagnosed with low-risk, low-volume PCa who were treated by RP to see if the surgical specimens of the black men showed more features of aggressive PCa than those of the white men.[ii] The authors identified 1794 cases of black and white men (2010-2011) whose pre-surgery diagnosis included features that generally qualify patients for AS:
- Gleason 6 (3+3)
- PSA < 10 ng/mL
- Less than or equal to 2 positive needles out of a 12 core biopsy
- Stage less than or equal to T1c
In this study group, all of the men chose surgery rather than AS. The lab results of examining the post-surgery specimens are called “histopathology.” As you may know, histopathology frequently reveals PCa traits that were missed by the biopsy, such as higher Gleason score (upgrading) of the cancer. The study authors defined unfavorable histopathology features as
- Gleason greater than or equal to 4+3 with stage T2 or
- Gleason 3+3 with stage T3a and positive margins, or
- Gleason greater than or equal to 3+4 with stage T3a, or
- Any Gleason score with stage T3b-T4
What do you think they found? There were NO statistically significant differences between African American and Caucasian men regarding Gleason score, extent of disease, positive margins and Cancer of the Prostate Risk Assessment score.
Thus, African American men with low-risk, low-volume PCa were found to have no more aggressive PCa features than their Caucasian counterparts who all had the same initial diagnosis. While this study sheds no light on why there appears to be a higher incidence of PCa among black men, it’s good news. In finding no evidence of a more aggressive PCa nature among black men, the authors wrote that their data support AS among black men with low-risk, low-volume prostate cancer.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Nair SS, Chakravarty D, Dovey ZS, Zhang X, Tewari AK. Why do African-American men face higher risks for lethal prostate cancer? Curr Opin Urol. 2022 Jan 1;32(1):96-101.
[ii] Schreiber D, Chhabra A, Rineer J et al. A population-based study of men with low-volume low-risk prostate cancer: Does African-American race predict for more aggressive disease? Clin Genitourin Cancer. 2015 Feb 21. Doi: 10.1016/j.clgc.2015.02.006
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
