Prostate Cancer Patients Of African Descent Present With Higher Grade Disease Are Younger Have Higher Psa Levels And Have A Greater Incidence Of Metastatic Disease
If you are a man of African ancestry, prostate cancer needs to be on your radar. This is because, of all the men in the world, you are in the group that prostate cancer hits the hardest. Prostate cancer is different in you than it is in other men. It can be more serious.
This is not fear-mongering its the truth: You are not only more likely to be diagnosed with prostate cancer, but also to have a more aggressive form that needs to be treated. You are more than twice as likely to die of prostate cancer as a man of a different heritage. So if you are a man of African descent and you are diagnosed with prostate cancer, you will more likely need to go after it with curative treatment surgery or radiation. Active surveillance may not be the best option for you. And you need to get a baseline PSA and prostate exam starting at age 40.
Genetic inheritance your genes actually discriminate against a man biologically, biochemically, and genetically,If we can understand this more aggressive form of prostate cancer, it is going to help all men.
But in a striking development, we also found that about one-third of these markers behaved ininverse fashion in black men compared to Caucasians. This means that a marker that goes up in white men to signal cancer actually goes down in men of African ancestry when cancer or aggressive cancer is present. In men of African ancestry, a lot of established biomarkers are not the same as the established markers in Caucasians.
Our Work Has Shown That Prostate Cancers In Black Men Can Make Less Psa Per Gram Of Cancer Compared To Prostate Cancers In Caucasian Men
Currently, the ideal values for a safe PSA in an African-American man are not well established. Even more troubling: Some of the most aggressive prostate cancers never produce PSA at a high level, he adds.
Note: Thats why it is important to get regular prostate exams in addition to PSA tests. About 20 percent of prostate cancers are diagnosed by a rectal exam, and not by any noticeable level of PSA. So if you are a black man, Schaeffer advises, it is important to understand your numbers, and to partner with a urologist who appreciates that your PSA score needs special attention.
To be extra cautious, Schaeffer gets MRI images of his patients who are at highest risk of prostate cancer men with a strong family history, and African-American men and does an MRI-guided biopsy. Most biopsies are directed by transrectal ultrasound, but MRI is able to help spot cancers that are hiding in the nooks and crannies of the prostate.
Genetic inheritance your genes actually discriminate against a man biologically, biochemically, and genetically,If we can understand this more aggressive form of prostate cancer, it is going to help all men.
Discovery Paves Way To Precision Medicine For Prostate Cancer In All Races
Edward Schaeffer, MD, chair and the Edmund Andrews Professor of Urology and a Northwestern Medicine urologist, was the senior author of the study.
Black men die more often of prostate cancer yet, paradoxically, have greater survival benefits from immunotherapy treatment. A new Northwestern Medicine study has discovered the reason appears to be an increase of a surprising type of immune cell in the tumor. The findings, in Nature Communications, could lead to immune-based precision medicine treatment for men of all races with localized aggressive and advanced prostate cancer.
In the new study, Northwestern scientists showed tumors from Black men and men of African ancestry have an increased proportion of a special immune cell called plasma cells compared to the tumors of white men. A research team lead by Edward Schaeffer, MD, chair and the Edmund Andrews Professor of Urology and a Northwestern Medicine urologist, found this increase in plasma cells correlated with improved cancer survival following surgery and identified plasma cells as potential drivers of prostate cancer immune-responsiveness.
If a mans prostate cancer has numerous plasma cells, we found he had improved cancer survival, said Schaeffer, who is also program director of the Genitourinary Oncology Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Our study suggests plasma cells are important in the bodys response to cancer.
Recommended Reading: Do Females Have Prostate Cancer
Treatment Delivery And Response
âWe know that Black men have delayed diagnoses — and, therefore, treatment,â Mucci says. âThey also tend to get different types of treatment, and their access to care is different,â she says. Yamoah cautions that âWeâre not asking doctors to treat Black men with prostate cancer differently ⦠we need to treat based on their biology.â
We still donât know whether certain prostate cancer treatments work as well for Black men, Mucci says. But Mahal points out that âIn radiation trials where patients had the same disease status and equal access to care, Black men actually had a better prostate cancer survival rate than others.â He adds that their overall death rates were higher, but that this may have been due to having more than one illness.
How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
Recommended Reading: Is Zinc Good For Prostate
Black Men And Prostate Cancer
What does the research say?
- According to a study published in Cancer Reports, African Americans have higher rates of prostate cancer and are more likely to die from the disease than other groups in the United States.
- A separate study published in JAMA found that though African American men face a greater risk of prostate cancer progression, the increased risk does not translate to an increased risk of death.
- Urological surgeon Professor Frank Chinegwundoh revealed that
- Black men in the UK are 2-3 times more likely to develop prostate cancer,
- The death rate is twice as high
- Black men in the UK are more likely to develop prostate cancer at a younger age
Do Prostate Cancer Disparities Differ By Grade
Compared with white men, African American men are more likely to develop prostate cancer and are twice as likely to die from the disease.
But, before Dr. Huangs study, it wasnt clear if the disparity in prostate cancer death occurred equally across all disease grades or if it occurred mainly in one grade, he said.
It was a question that we were surprised hadnt really been addressed, he added.
So, the researchers analyzed data from NCIs Surveillance, Epidemiology, and End Results program. First, they used a specialized SEER database containing information on more than 190,000 men with prostate cancer who underwent active surveillance, or watchful waiting, between 2010 and 2015. Patients were followed for a median of 3 years.
Active surveillance is one of several options for the management of localized low-grade prostate cancer, as is immediate treatment with surgery or radiation. Each individual patient and his doctor should make that decision together, Dr. Huang explained.
The specialized SEER database also includes information on socioeconomic statusa measurement of a persons income, education, and occupation. Socioeconomic differences can lead to health disparities such as access to treatment.
Read Also: Would You Expect A Male With Benign Prostatic Hyperplasia To Have Difficulty With Ejaculation
Risk Factors In Aggressive Vs Slow
In the past few years, weve learned that prostate cancer really is several diseases with different causes. More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.
For example, while smoking has not been thought to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer. Likewise, lack of vegetables in the diet is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.
Body mass index, a measure of obesity, is not linked to being diagnosed with prostate cancer overall. In fact, obese men may have a relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume. However, obese men are more likely to have aggressive disease.
Other risk factors for aggressive prostate cancer include:
- Tall height
- Agent Orange exposure
Research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease. You can learn more about how dietary and lifestyle changes can affect the risk of prostate cancer development and progression in PCFs Health and Wellness: Living with Prostate Cancer guide.
Dont Miss: How To Massage A Mans Prostate
Do Not Stuff Yourself
The Japanese enjoy a long life expectancy, and the highest percentage of centenarians in the world is found in Okinawa. If you want to learn how to live to 100, follow the eating style of people who live there. They have a practice of eating until they are only 80 percent full. This makes good sense because it takes 20 minutes for the brain to receive the signal from your stomach that it is full. Stop eating before you feel full. Over time, not cleaning your plate adds up to weight loss.
Also Check: Prostate Definition Medical
Am I At Risk Of Prostate Cancer
In the UK, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. We dont know exactly what causes prostate cancer but there are some things that may mean you are more likely to get it these are called risk factors.
There are three main risk factors for getting prostate cancer, which are things you cant change. These are:
If you have any of these risk factors or if you have any symptoms, speak to your GP. They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer. You can also get in touch with our Specialist Nurses, who can help you understand your risk of prostate cancer.
Cap Amongst Black Men In The Uk
Despite a large AC contingent in the UK, there are few studies on the incidence and mortality of prostate cancer in this group in comparison with a high volume of studies originating in the US.
One of the first studies in the UK reporting ethnic variations in CaP was an audit of 359 newly diagnosed men between 1999 and 2000 in North and East London . The age-specific incidence rates for every age group were three times higher in ACs compared to Europeans. Similarly, there was a three times greater risk for men under the age of 70 in this group, as ACs would be diagnosed earlier than Europeans and South Asians . South Asians generally had the lowest risk, although notably this group was under-represented in this cohort. There was no significant difference in Gleason score, presenting PSA, and stage, although a modest increase was seen in the first two.
This study generated interest in this field and resulted in a collaboration known as the Prostate Cancer in Ethnic Subgroups study group . Between 1997 and 2001, the data were analysed from a larger retrospective cohort in London and Bristol, cities with a relatively high populous of black communities. There was an inclusion of 2140 incident cases with a demographic spread of 1315 white, 435 black Caribbean, 102 black African, 128 other ethnic groups, and 149 uncoded ethnicities.
Recommended Reading: How Effective Is Chemotherapy For Prostate Cancer
The Psa Test For Prostate Cancer Is Less Than Perfect
Your doctor will tell you to get a PSA test and a digital rectal exam every year. But this autopsy study suggests thats not nearly enough. All of the men in the study had a normal result on both of these tests. In fact, another study says these tests are not very accurate at all.
In 2004, the New England Journal of Medicine published a study that reveals just how inaccurate a normal PSA reading can be.
The authors of the study wondered how often men with both a normal PSA and a normal rectal examination actually had prostate cancer.
These researchers must have done some fast talking. Somehow, they managed to talk 2,950 men into having their prostates biopsied simply as part of their research. None of the men had any indication at all that they were any more likely to have prostate cancer than the average man with normal tests.
What they found was startling. Of these nearly 3,000 men, 449 men actually had cancer despite their normal test scores. Thats one in seven.
That means that for every seven men who have normal findings, one of them has cancer. And the doctors missed it. Whats more, the actual number of the PSA score doesnt offer much help either.
- 6.6 percent of the 449 had an extremely low PSA that was less than 0.5.
- 10.1 percent had PSAs between 0.6 and 1.0.
- 17.0 percent had PSAs between 1.1 to 2.0.
- 23.9 percent had values of 2.1 to 3.0.
- And 26.9 percent had levels between 3.1 to 4.0.
Everyone Older Than 60 Has Cancer
Doctors are finally realizing that most people have cancer in their body. But its latent or hidden cancer. Latent cancers are so well contained by the immune system that they never get large enough to cause problems. As a result, doctors rarely discover them, unless they discover them by accident. Most of the cancers they discovered in this autopsy study were latent cancers. And, as you can see, they are very common.
Autopsy studies on women, for example, show that by the time a woman is 40 years old, the chance of her having a latent breast cancer is 40 percent.
That sounds terrible, doesnt it? Its really not terrible. In fact, the existence of latent cancers is very reassuring. They clearly demonstrate how effective a healthy immune system can be in stopping cancer.
Its so effective that the great majority of latent cancers never go on to become full-blown cancers. Thats good news. When you start to add up all of the various autopsy studies that are published, you soon realize that every single one of us over the age of 60 has cancer. Actually, we have at least two of these cancers already living in our bodies. But the really important thing about latent cancers is that they can teach us a lot.
The first thing they teach us is that by maintaining a healthy immune system, we can dramatically decrease our chances of dying from cancer.
Whats the best way to do this?
Read Also: Prostate Disease Definition
Black Men And Their Doctors Should Be More Cautious About Active Surveillance
Active surveillance is an approach in which low-risk prostate cancer is not treated with surgery or radiation therapy. Instead, it is monitored very closely for any signs of change over months or years. Active surveillance is increasingly the treatment option of choice for low-risk prostate cancer. Many men embrace this approach because the side effects of treatment, usually surgery or radiation therapy, can be significant.
Black men, however, are more likely to develop more-aggressive prostate cancer. Because of that, Dr. Kantoff maintains that active surveillance may be less appropriate for many Black men. As with screening guidelines, there is little evidence to provide guidance one way or the other. Blacks have been underrepresented in active surveillance studies as well.
Having said that, I think some Black men could benefit from active surveillance, Dr. Kantoff says. This question needs to be studied more before we can come to firm recommendations.
Origins Of African Caribbeans In Western Countries
The majority of Black men currently living in Western countries are descendants of those who originated from the transatlantic slave trade between 1450 and 1900 where African slaves were exported mainly to the Americas, Europe, and the Caribbean . Odedina et al comment that the burden of CaP amongst black men originating from West Africa clearly follows the path of the TAST .
ACs have settled in the UK for at least 300 years however, the Windrush generation is responsible for the mass introduction of immigrants from the British Empire who remain in the UK today. The AC population represents a diverse group of individuals who are mostly indigenous to Africa, yet also comprise Europeans and Asian-Indians, representing the heterogeneity of the gene pool due to generations of interbreeding.
Strong cultural habits and traditions remain in migrant communities, which has an unknown impact on health-seeking behaviours therefore, caution should be used while interpreting data between ethnic groups, as possible reasons for disparities are likely multifactorial.
Don’t Miss: Perineural Invasion Meaning
Cqc: Competence Quality Caring
When respondents were asked about quality services, nearly 40% felt the healthcare system is not designed to help African American men. Our respondents felt that black men did not have prostate cancer screening because they are not aware they should be screened , they believed they are not at risk , or the doctor never mentioned it . Additionally, 62.8% felt they were treated badly because of their race, and 45.2% believed they received poor quality of health care due to their race.
I know that in areas where people are underserved the attitude of the people giving the service is superiority. If you dont like it, leave. I have had insurance forever, and no ones talked to me about prostate cancer. 50-year-old key informant
Minorities, because they dont get a chance to see the doctor like the other populations, have the trust thing. If he doesnt talk right to you, if you dont get the idea that hes concerned with you enough, then you go to another doctor. 62-year-old participant in Community Focus Group #2