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Ogunsanya ME, Kaninjing E, Ellis TN, Bamidele OO, Morton DJ, McIntosh AG, Dickey SL, Kendzor DE, Dwyer K, Young ME, Odedina FT. Quality of life assessment among ethnically diverse Black prostate cancer survivors: a constructivist grounded theory approach. J Cancer Surviv 2024:10.1007/s11764-024-01619-x. [PMID: 38805150 DOI: 10.1007/s11764-024-01619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Prostate cancer (CaP) is the most common cancer in Black men (BM), and the number of Black CaP survivors is rapidly increasing. Although Black immigrants are among the fastest-growing and most heterogeneous ethnic groups in the USA, limited data exist regarding their CaP experiences. Therefore, this study aimed to explore and model the experiences of ethnically diverse Black men with CaP. METHODS In-depth interviews were conducted with 34 participants: native-born BM (NBBM) (n = 17), African-born BM (ABBM) (n = 11), and Caribbean-born BM (CBBM) (n = 6) CaP survivors recruited through QR code-embedded flyers posted in Black businesses, clinics, social media platforms, and existing research networks within the USA. Guided by Charmaz's constructivist grounded theory methodology, the interviews were analyzed using constant comparison following key stages of initial, focused, and theoretical coding using Atlas.ti v23. RESULTS Participants were thirty-four men aged 49-84 years (mean ± SD, 66 ± 8). Most were married (77%), likely to be diagnosed at stage I (35%), and treated with radiotherapy (56%). Our study findings explored the complex trajectory of Black prostate cancer (CaP) survivors, unveiling a comprehensive model termed "Journeying through Unfamiliar Terrain." Comprising three phases and 11 sub-phases, this model uniquely captures the pre-diagnosis awareness and post-treatment adaptation among survivors. CONCLUSION The resulting theoretical model delineates the entire CaP survivorship process among BM, providing contextual and conceptual understanding for developing interventions and enhancing patient-centered care for ethnically diverse CaP survivors, pivotal in bridging the gaps in survivorship research and healthcare practices. IMPLICATIONS FOR CANCER SURVIVORS Black CAP survivors experience significant burdens and challenges that impact their overall quality of life. Understanding the factors that impact the complex survivorship journey can inform design and implementation of interventions to address the multiple challenges and thus improve quality of life.
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Affiliation(s)
- Motolani E Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
| | - Ernest Kaninjing
- School of Health and Human Performance, Georgia College & State University, Milledgeville, GA, USA
| | - Tanara N Ellis
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Olufikayo O Bamidele
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Daniel J Morton
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Andrew G McIntosh
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Kathleen Dwyer
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Mary Ellen Young
- Prevention, Symptom Control and Survivorship, and Care Delivery Transformation (CPSD) Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL, USA
| | - Folakemi T Odedina
- Prevention, Symptom Control and Survivorship, and Care Delivery Transformation (CPSD) Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL, USA
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Lewis DD, Cropp CD. The Impact of African Ancestry on Prostate Cancer Disparities in the Era of Precision Medicine. Genes (Basel) 2020; 11:E1471. [PMID: 33302594 PMCID: PMC7762993 DOI: 10.3390/genes11121471] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer disproportionately affects men of African ancestry at nearly twice the rate of men of European ancestry despite the advancement of treatment strategies and prevention. In this review, we discuss the underlying causes of these disparities including genetics, environmental/behavioral, and social determinants of health while highlighting the implications and challenges that contribute to the stark underrepresentation of men of African ancestry in clinical trials and genetic research studies. Reducing prostate cancer disparities through the development of personalized medicine approaches based on genetics will require a holistic understanding of the complex interplay of non-genetic factors that disproportionately exacerbate the observed disparity between men of African and European ancestries.
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Affiliation(s)
- Deyana D. Lewis
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, Baltimore, MD 21224, USA
| | - Cheryl D. Cropp
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University McWhorter School of Pharmacy, Birmingham, AL 35229, USA;
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Guerrios-Rivera L, Howard LE, Klaassen Z, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Aronson WJ, Freedland SJ. Do Hispanic Men Have Worse Outcomes After Radical Prostatectomy? Results From SEARCH. Urology 2020; 149:181-186. [PMID: 33189734 DOI: 10.1016/j.urology.2020.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the associations between ethnicity and outcomes after radical prostatectomy (RP) among Hispanics. While non-Hispanic Black men have worse prostate cancer (PC) outcomes, there are limited data on outcomes of Hispanic men, especially after RP. METHODS We identified 3789 White men who underwent RP between 1988 and 2017 in the Shared Equal Access Regional Cancer Hospital database. Men were categorized as Hispanic or non-Hispanic. Logistic regression was used to test the association between ethnicity and PC adverse features. Cox models were used to test the association between ethnicity and biochemical recurrence (BCR), metastases, and castration-resistant PC (CRPC). All models were adjusted for age, prostate-specific antigen, clinical stage, biopsy grade group, surgery year, and surgical center. RESULTS Of 3789 White men, 236 (6%) were Hispanic. Hispanic men had higher prostate-specific antigen, but all other characteristics were similar between ethnicities. On multivariable analysis, there was no difference between ethnicities in odds of extracapsular extension, seminal vesicle invasion, positive margins, positive lymph nodes, or high-grade disease (odds ratio 0.62-0.89, all P > .07). A total of 1168 men had BCR, 182 developed metastasis, and 132 developed CRPC. There was no significant association between Hispanic ethnicity and risk of BCR, metastases, or CRPC (hazards ratio 0.39-0.85, all P > .06). CONCLUSION In an equal access setting, we found no evidence Hispanic White men undergoing RP had worse outcomes than non-Hispanic White men. In fact, all hazard ratios were <1 and although they did not achieve statistical significance, suggest perhaps slightly better outcomes for Hispanic men. Larger studies are needed to confirm findings.
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Affiliation(s)
- Lourdes Guerrios-Rivera
- Urology Section, Surgery Department, Veterans Administration Caribbean Health Care System, San Juan, Puerto Rico; University of Puerto Rico, Medical Sciences Campus
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, NC; Section of Urology, Division of Surgery, Durham VA Medical Center, Durham, North Carolina
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Augusta University - Medical College of Georgia, Georgia
| | - Martha K Terris
- Department of Surgery, Section of Urology, Augusta University - Medical College of Georgia, Georgia; Section of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA
| | | | - Christopher L Amling
- Department of Urology, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - Christopher J Kane
- Department of Urology, University of California, San Diego CA; VA San Diego Healthcare System, San Diego, California
| | - William J Aronson
- Department of Urology, University of California, Los Angeles, California; Wadsworth VA Medical Center, Los Angeles, California
| | - Stephen J Freedland
- Section of Urology, Division of Surgery, Durham VA Medical Center, Durham, North Carolina; Center for Integrated Research in Cancer and Lifestyle, Division of Urology, Department of Surgery, and the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Faisal FA, Murali S, Kaur H, Vidotto T, Guedes LB, Salles DC, Kothari V, Tosoian JJ, Han S, Hovelson DH, Hu K, Spratt DE, Baras AS, Tomlins SA, Schaeffer EM, Lotan TL. CDKN1B Deletions are Associated with Metastasis in African American Men with Clinically Localized, Surgically Treated Prostate Cancer. Clin Cancer Res 2020; 26:2595-2602. [PMID: 31969336 DOI: 10.1158/1078-0432.ccr-19-1669] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/25/2019] [Accepted: 01/17/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE The potential biological determinants of aggressive prostate cancer in African American (AA) men are unknown. Here we characterize prostate cancer genomic alterations in the largest cohort to date of AA men with clinical follow-up for metastasis, with the aim to elucidate the key molecular drivers associated with poor prognosis in this population. EXPERIMENTAL DESIGN Targeted sequencing was retrospectively performed on 205 prostate tumors from AA men treated with radical prostatectomy (RP) to examine somatic genomic alterations and percent of the genome with copy-number alterations (PGA). Cox proportional hazards analyses assessed the association of genomic alterations with risk of metastasis. RESULTS At RP, 71% (145/205) of patients had grade group ≥3 disease, and 49% (99/202) were non-organ confined. The median PGA was 3.7% (IQR = 0.9%-9.4%) and differed by pathologic grade (P < 0.001) and stage (P = 0.02). Median follow-up was 5 years. AA men with the highest quartile of PGA had increased risks of metastasis (multivariable: HR = 13.45; 95% CI, 2.55-70.86; P = 0.002). The most common somatic mutations were SPOP (11.2%), FOXA1 (8.3%), and TP53 (3.9%). The most common loci altered at the copy number level were CDKN1B (6.3%), CHD1 (4.4%), and PTEN (3.4%). TP53 mutations and deep deletions in CDKN1B were associated with increased risks of metastasis on multivariable analyses (TP53: HR = 9.5; 95% CI, 2.2-40.6; P = 0.002; CDKN1B: HR = 6.7; 95% CI, 1.3-35.2; P = 0.026). CONCLUSIONS Overall, PGA, somatic TP53 mutations, and a novel finding of deep deletions in CDKN1B were associated with poor prognosis in AA men. These findings require confirmation in additional AA cohorts.
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Affiliation(s)
- Farzana A Faisal
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjana Murali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harsimar Kaur
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thiago Vidotto
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Liana B Guedes
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniela Correia Salles
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vishal Kothari
- Polsky Urologic Cancer Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey J Tosoian
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sumin Han
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel H Hovelson
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kevin Hu
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel E Spratt
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alexander S Baras
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Scott A Tomlins
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan. .,Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Edward M Schaeffer
- Polsky Urologic Cancer Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Tamara L Lotan
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. .,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Everist MM, Howard LE, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Terris MK, Freedland SJ. Socioeconomic status, race, and long-term outcomes after radical prostatectomy in an equal access health system: Results from the SEARCH database. Urol Oncol 2018; 37:289.e11-289.e17. [PMID: 30598238 DOI: 10.1016/j.urolonc.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We previously found racial differences in biochemical recurrence (BCR) after radical prostatectomy (RP) persisted after adjusting for socioeconomic status (SES) while SES did not predict BCR. The impact on long-term prostate cancer (PC) outcomes is unclear. We hypothesized higher SES would associate with better long-term outcomes regardless of race. METHODS Among 4,787 black and white men undergoing RP from 1988 to 2015 in the SEARCH Database, poverty (primary SES measure) was estimated by linking home ZIP-code to census data. Cox models were used to test the association between SES adjusting for demographic, clinicopathological features, and race with BCR, castration-resistant PC (CRPC), metastases, PC-specific mortality (PCSM), and all-cause mortality. Interactions between race and SES were tested. RESULTS Median follow-up was 98 months (Interquartile range: 54-150 months). There were no interactions between race and SES for BCR. Black men had 10%- to 11% increased BCR risk (P < 0.06) while SES was unrelated to BCR. There were interactions between SES and race for CRPC (P = 0.002), metastasis (P = 0.014), and PCSM (P = 0.004). Lower SES was associated with decreased CRPC (P = 0.012), metastases (P = 0.004), and PCSM (P = 0.049) in black, but not white men (all P ≥ 0.22). Higher SES was associated with decreased all-cause mortality in both races. CONCLUSIONS In an equal-access setting, lower SES associated with decreased CRPC, metastases, and PCSM in black but not white men. If confirmed, these findings suggest a complex relationship between race, SES, and PC with further research needed to understand why low SES in black men decreased the risk for poor PC outcomes after RP.
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Affiliation(s)
- Mary M Everist
- Division of Urology, Veterans Affairs Medical Center, Durham, NC
| | - Lauren E Howard
- Division of Urology, Veterans Affairs Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - William J Aronson
- Department of Urology, UCLA School of Medicine, Los Angeles, CA; Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Christopher J Kane
- Urology Department, University of California San Diego Health System, San Diego, CA
| | | | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, GA; Section of Urology, Medical College of Georgia, Augusta, GA
| | - Stephen J Freedland
- Division of Urology, Veterans Affairs Medical Center, Durham, NC; Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
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6
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Dickey SL, Ogunsanya ME. Quality of Life Among Black Prostate Cancer Survivors: An Integrative Review. Am J Mens Health 2018; 12:1648-1664. [PMID: 29926761 PMCID: PMC6142144 DOI: 10.1177/1557988318780857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/27/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022] Open
Abstract
The purpose of this integrative review was to explore the impact of prostate cancer (PCa) on the quality of life (QoL) and factors that contribute to the QoL for Black men with PCa. Prostate is recognized as the prevalent cancer among men in the United States. Compared to other men, Black men are diagnosed more frequently and with more advanced stages of PCa. Black men also experience disproportionately higher morbidity and mortality rates of PCa, among all racial and ethnic groups. The initial diagnosis of PCa is often associated with a barrage of concerns for one's well-being including one's QoL. As a result, men must contend with various psychosocial and physiological symptoms of PCa survivorship. Whittemore and Knafl's integrative review method was utilized to examine empirical articles from the electronic databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed, Project Muse, and Google Scholar. The time frame for the literature was January 2005 to December 2016. A synthesis of the literature yielded 18 studies that met the inclusion criteria for the integrative review. A conceptual framework that examined QoL among cancer survivors identified four domains that measured the QoL among Black PCa survivors: (a) physical; (b) psychological; (c) social; and (d) spiritual well-being. Social well-being was the dominant factor among the studies in the review, followed by physical, psychological, and spiritual. Results indicate the need for additional studies that examine the factors impacting the QoL among Black PCa survivors, using a theoretical framework so as to develop culturally appropriate interventions for Black PCa survivors.
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Affiliation(s)
| | - Motolani E. Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Do Sociodemographic Factors Influence Outcome in Prostate Cancer Patients Treated With External Beam Radiation Therapy? Am J Clin Oncol 2016; 39:563-567. [DOI: 10.1097/coc.0000000000000093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Powell IJ, Bollig-Fischer A. Minireview: the molecular and genomic basis for prostate cancer health disparities. Mol Endocrinol 2013; 27:879-91. [PMID: 23608645 DOI: 10.1210/me.2013-1039] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite more aggressive screening across all demographics and gradual declines in mortality related to prostate cancer (PCa) in the United States, race disparities persist. For African American men (AAM), PCa is more often an aggressive disease showing increased metastases and greater PCa-related mortality compared with European American men. The earliest research points to how distinctions are likely the result of a combination of factors, including ancestry genetics and lifestyle variables. More recent research considers that cancer, although influenced by external forces, is ultimately a disease primarily driven by aberrations observed in the molecular genetics of the tumor. Research studying PCa predominantly from European American men shows that indolent and advanced or metastatic prostate tumors have distinguishing molecular genomic make-ups. Early yet increasing evidence suggests that clinically distinct PCa from AAM also display molecular distinctions. It is reasonable to predict that further study will reveal molecular subtypes and various frequencies for PCa subtypes among diverse patient groups, thereby providing insight as to the genomic lesions and gene signatures that are functionally implicated in carcinogenesis or aggressive PCa in AAM. That knowledge will prove useful in developing strategies to predict who will develop advanced PCa among AAM and will provide the rationale to develop effective individualized treatment strategies to overcome disparities.
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Affiliation(s)
- Isaac J Powell
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan 48201, USA.
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Koscuiszka M, Hatcher D, Christos PJ, Rose AE, Greenwald HS, Chiu YL, Taneja SS, Mazumdar M, Lee P, Osman I. Impact of race on survival in patients with clinically nonmetastatic prostate cancer who deferred primary treatment. Cancer 2011; 118:3145-52. [PMID: 22020835 DOI: 10.1002/cncr.26619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/26/2011] [Accepted: 09/19/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate cancer (PCa) racial disparity studies typically focus on survival differences after curative treatment. The authors of this report hypothesized that comparing mortality rates between African American (AA) and Caucasian American (CA) patients who deferred primary treatment for clinically nonmetastatic PCa may provide a better assessment of the impact of race on the natural course of PCa. METHODS The pathology database of the New York Veterans Administration Medical Center (VAMC), an equal access-of-care facility, was searched for patients with biopsy-proven PCa. Inclusion criteria included 1) no evidence of metastatic disease or death within 3 years after diagnosis, 2) no primary treatment, and 3) a minimum of 5 years of follow-up for survivors. RESULTS In total, 518 patients met inclusion criteria between 1990 and 2005. AA patients were younger (P = .02) and had higher median prostate-specific antigen (PSA) levels (P = .001) at the time of diagnosis compared with CA patients. In a multivariate model, higher Gleason score and PSA level were associated with increased mortality (P = .001 and P = .03, respectively), but race was not a predictor of death from PCa. CONCLUSIONS The current data suggested that race did not have a major impact on survival in patients with PCa who deferred primary treatment for clinically nonmetastatic disease.
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Affiliation(s)
- Michael Koscuiszka
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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10
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Chornokur G, Dalton K, Borysova M, Kumar N. Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer. Prostate 2011; 71:985-97. [PMID: 21541975 PMCID: PMC3083484 DOI: 10.1002/pros.21314] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/02/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate cancer (PCa) remains the most common malignancy and the second leading cause of cancer death among men in the United States. PCa exhibits the most striking racial disparity, as African American men are at 1.4 times higher risk of being diagnosed, and 2-3 times higher risk of dying of PCa, compared to Caucasian men. The etiology of the disparity has not been clearly elucidated. The objective of this article is to critically review the literature and summarize the most prominent PCa racial disparities accompanied by proposed explanations. METHODS The present literature on disparities at presentation, diagnosis, treatment, and survival of African American men affected by PCa was systematically reviewed. Original research as well as relevant review articles were included. RESULTS African American men persistently present with more advanced disease than Caucasian men, are administered different treatment regimens than Caucasian men, and have shorter progression-free survival following treatment. In addition, African American men report more treatment-related side-effects that translates to the diminished quality of life (QOL). CONCLUSIONS PCa racial disparity exists at stages of presentation, diagnosis, treatment regimens, and subsequent survival, and the QOL. The disparities are complex involving biological, socio-economic, and socio-cultural determinants. These mounting results highlight an urgent need for future clinical, scientific, and socio-cultural research involving transdisciplinary teams to elucidate the causes for PCa racial disparities.
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Affiliation(s)
- Ganna Chornokur
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
| | - Kyle Dalton
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
| | - Meghan Borysova
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
| | - Nagi Kumar
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
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11
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Rose AE, Satagopan JM, Oddoux C, Zhou Q, Xu R, Olshen AB, Yu JZ, Dash A, Jean-Gilles J, Reuter V, Gerald WL, Lee P, Osman I. Copy number and gene expression differences between African American and Caucasian American prostate cancer. J Transl Med 2010; 8:70. [PMID: 20649978 PMCID: PMC2913940 DOI: 10.1186/1479-5876-8-70] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/22/2010] [Indexed: 11/26/2022] Open
Abstract
Background The goal of our study was to investigate the molecular underpinnings associated with the relatively aggressive clinical behavior of prostate cancer (PCa) in African American (AA) compared to Caucasian American (CA) patients using a genome-wide approach. Methods AA and CA patients treated with radical prostatectomy (RP) were frequency matched for age at RP, Gleason grade, and tumor stage. Array-CGH (BAC SpectralChip2600) was used to identify genomic regions with significantly different DNA copy number between the groups. Gene expression profiling of the same set of tumors was also evaluated using Affymetrix HG-U133 Plus 2.0 arrays. Concordance between copy number alteration and gene expression was examined. A second aCGH analysis was performed in a larger validation cohort using an oligo-based platform (Agilent 244K). Results BAC-based array identified 27 chromosomal regions with significantly different copy number changes between the AA and CA tumors in the first cohort (Fisher's exact test, P < 0.05). Copy number alterations in these 27 regions were also significantly associated with gene expression changes. aCGH performed in a larger, independent cohort of AA and CA tumors validated 4 of the 27 (15%) most significantly altered regions from the initial analysis (3q26, 5p15-p14, 14q32, and 16p11). Functional annotation of overlapping genes within the 4 validated regions of AA/CA DNA copy number changes revealed significant enrichment of genes related to immune response. Conclusions Our data reveal molecular alterations at the level of gene expression and DNA copy number that are specific to African American and Caucasian prostate cancer and may be related to underlying differences in immune response.
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Affiliation(s)
- Amy E Rose
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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12
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Powell IJ, Bock CH, Ruterbusch JJ, Sakr W. Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in black than in white American men, and influences racial progression and mortality disparity. J Urol 2010; 183:1792-6. [PMID: 20299055 DOI: 10.1016/j.juro.2010.01.015] [Citation(s) in RCA: 208] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE The incidence of prostate cancer is approximately 60% higher and the mortality rate is 2 to 3 times greater in black than in white American men. We propose that a more rapid prostate cancer growth rate and/or earlier transformation from latent to aggressive prostate cancer in black than in white men contribute to this disparity. MATERIALS AND METHODS We evaluated entirely embedded prostate glands on autopsy from 1,056 black and white men who died of causes other than prostate cancer. We also reviewed data from our radical prostatectomy database and from the Detroit Surveillance, Epidemiology and End Results database. RESULTS Autopsy data indicated that subclinical prostate cancer in black and white men starts at early age and clinical characteristics do not differ by race at early ages. Radical prostatectomy specimen data revealed that prostate cancer volume and Gleason grade were greater in black than in white men. Advanced or metastatic prostate cancer occurred at a 4:1 ratio in black and white men, respectively, in the Detroit Surveillance, Epidemiology and End Results registry database. CONCLUSIONS Results showed that age at prostate cancer initiation and clinical characteristics did not differ by race in our autopsy series, prostate cancer volume after radical prostatectomy was greater in black than in white men and disease became distant disease at a ratio of 4 black men to 1 white man in the Detroit Surveillance, Epidemiology and End Results population. These findings support the concept that prostate cancer grows more rapidly in black than in white men and/or earlier transformation from latent to aggressive prostate cancer occurs in black than in white men.
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Affiliation(s)
- Isaac J Powell
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan, USA.
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Hatcher D, Daniels G, Osman I, Lee P. Molecular mechanisms involving prostate cancer racial disparity. Am J Transl Res 2009; 1:235-248. [PMID: 19956434 PMCID: PMC2776319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/17/2009] [Indexed: 05/28/2023]
Abstract
African American (AA) men with prostate cancer (PCa) have worse disease, with a higher incidence, younger age and more advanced disease at diagnosis, and a worse prognosis, compared to Caucasian (CA) men. In addition to socioeconomic factors and lifestyle differences, molecular alterations contribute to this discrepancy. In this review, we summarize molecular genetics research results interrelated with the biology of PCa racial disparity. Androgen and androgen receptor (AR) pathways have long been associated with prostate growth. Racial differences have also been found among variants of the genes of the enzymes involved in androgen biosynthesis and metabolism, such as SRD5A2, CYP17, and CYP3A4. The levels of expression and CAG repeat length of AR also show racial divergence and may be critical molecular alterations for racial disparity. Growth factors and their receptors, which promote cancer cell growth, are another potential cause of the disparity; both EGFR and EPHB2, two of the most studied receptors, show interethnic differences. Differences have also been found among genes regulating cell apoptosis, such as BCL2, which is increased in PCa in the AA population. Recent developments in genetics, proteomics, and genomics, among other molecular biotechnologies, will greatly aid the advancement of translational research on PCa racial disparity, hopefully culminating in the discovery of novel mechanisms of disease, in addition to prognostic markers and novel therapeutic approaches.
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Affiliation(s)
- David Hatcher
- Department of Pathology and Urology, New York University School of Medicine New York, NY
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