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Garraway IP, Carlsson SV, Nyame YA, Vassy JL, Chilov M, Fleming M, Frencher SK, George DJ, Kibel AS, King SA, Kittles R, Mahal BA, Pettaway CA, Rebbeck T, Rose B, Vince R, Winn RA, Yamoah K, Oh WK. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM EVIDENCE 2024; 3:EVIDoa2300289. [PMID: 38815168 DOI: 10.1056/evidoa2300289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. METHODS A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. CONCLUSIONS These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
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Affiliation(s)
- Isla P Garraway
- Department of Urology, David Geffen School of Medicine, University of California and Department of Surgical and Perioperative Care, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Sigrid V Carlsson
- Departments of Surgery and Epidemiology and Biostatistics, Urology Service, Memorial Sloan Kettering Cancer Center, New York
- Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, and Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle
- Department of Urology, University of Washington, Seattle
| | - Jason L Vassy
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford and Boston
- Harvard Medical School and Brigham and Women's Hospital, Boston
| | - Marina Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, New York
| | - Mark Fleming
- Virginia Oncology Associates, US Oncology Network, Norfolk, VA
| | - Stanley K Frencher
- Martin Luther King Jr. Community Hospital and University of California, Los Angeles
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Sherita A King
- Section of Urology, Medical College of Georgia at Augusta University and Charlie Norwood Veterans Affairs Medical Center, Augusta, GA
| | - Rick Kittles
- Morehouse School of Medicine, Community Health and Preventive Medicine, Atlanta
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, Miami
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Timothy Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
- Harvard T.H. Chan School of Public Health, Boston
| | - Brent Rose
- Department of Radiation Oncology, University of California, San Diego
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- James A. Haley Veterans' Hospital, Tampa, FL
| | - William K Oh
- Prostate Cancer Foundation, Santa Monica, CA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute at Mount Sinai, New York
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Hougen HY, Sjoberg DD, Thomas J, Mahal BA, Vickers AJ, Punnen S. Adding a Coefficient for Race to the 4Kscore Improves Calibration for Black Men. J Urol 2024; 211:392-399. [PMID: 38150383 PMCID: PMC10922923 DOI: 10.1097/ju.0000000000003834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Black men face a higher incidence of high-risk prostate cancer (PCa) compared with non-Black men. While the 4Kscore is a widely utilized commercial test for PCa risk assessment, it does not currently account for racial differences. The aim of this study is to describe and validate a prespecified race coefficient for the 4Kscore with the goal of improving the accuracy of this test for Black men. MATERIALS AND METHODS Using data from 85 Black men from the initial US prospective validation study, a race coefficient of 0.6 on the log-odds scale was prespecified. We calculated discrimination, calibration, and clinical utility of the 4Kscore with and without this coefficient for Black race in our primary analysis cohort of 205 Black men undergoing biopsy for PCa in a Veterans Affairs (VA) institution. We performed a sensitivity analysis using a combined cohort from the US prospective validation and the VA studies. RESULTS The mean probability of high-grade PCa from the 4Kscore in the primary cohort increased from 25% to 37% with race coefficient addition. Incorporating the race coefficient improved 4Kscore's calibration in Black men, with consequent improvements in clinical utility based on decision curve analysis. Model discrimination was maintained (AUC 0.825 vs 0.828, P = .14) in the combined cohort of Black and non-Black men from the US prospective and VA studies and the calibration remained largely unchanged. CONCLUSIONS Incorporating a prespecified coefficient for Black race improved calibration and clinical utility of the 4Kscore among Black men and should be added to the 4Kscore.
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Affiliation(s)
- Helen Y. Hougen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Daniel D. Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie Thomas
- Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
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Lee KM, Bryant AK, Lynch JA, Robison B, Alba PR, Agiri FY, Pridgen KM, DuVall SL, Yamoah K, Garraway IP, Rose BS. Association between prediagnostic prostate-specific antigen and prostate cancer probability in Black and non-Hispanic White men. Cancer 2024; 130:224-231. [PMID: 37927109 DOI: 10.1002/cncr.34979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Although Black men are more likely than non-Hispanic White men to develop and die from prostate cancer, limited data exist to guide prostate-specific antigen (PSA) screening protocols in Black men. This study investigated whether the risk for prostate cancer was higher than expected among self-identified Black than White veterans based on prebiopsy PSA level. METHODS Multivariable logistic regression models were estimated to predict the likelihood of prostate cancer diagnosis on first biopsy for 75,295 Black and 207,658 White male veterans. Self-identified race, age at first PSA test, prebiopsy PSA, age at first biopsy, smoking status, statin use, and socioeconomic factors were used as predictors. The adjusted predicted probabilities of cancer detection on first prostate biopsy from the logistic models at different PSA levels were calculated. RESULTS After controlling for PSA and other covariates, Black veterans were 50% more likely to receive a prostate cancer diagnosis on their first prostate biopsy than White veterans (odds ratio [OR], 1.50; 95% CI, 1.47-1.53; p < .001). At a PSA level of 4.0 ng/mL, the probability of prostate cancer for a Black man was 49% compared with 39% for a White man. This model indicated that Black veterans with a PSA of 4.0 ng/mL have an equivalent risk of prostate cancer as White veterans with a PSA of 13.4 ng/mL. CONCLUSIONS The findings indicate that, at any given PSA level, Black men are more likely to harbor prostate cancer than White men. Prospective studies are needed to better evaluate risks and benefits of PSA screening in Black men and other high-risk populations.
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Affiliation(s)
- Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alex K Bryant
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie A Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Brian Robison
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Patrick R Alba
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Fatai Y Agiri
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Kathryn M Pridgen
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
- James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Isla P Garraway
- Department of Surgical and Preoperative Care, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Urology and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brent S Rose
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California, USA
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Karaihira W, Karimi PN, Weru IW. Management and health-related quality of life among patients with prostate cancer in a Kenyan tertiary health facility. J Oncol Pharm Pract 2023:10781552231221110. [PMID: 38105481 DOI: 10.1177/10781552231221110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Advances made in the screening, diagnosis and management of prostate cancer have improved the survival rates of the patients. However, many of these treatments including surgery, radiotherapy, and pharmacotherapy, have an impact on the subsequent health-related quality of life (HRQoL) of these patients. Since it is an important prognostic factor of survival, failure to evaluate the HRQoL and its predictors in these patients typically results in long-term deficits in their overall well-being, that is, their physical, social, emotional, and mental health. The objective of this study was to evaluate the management and HRQoL among patients with prostate cancer at Kenyatta National Hospital. METHODS This was a descriptive cross-sectional study. The sample size of 62 patients who met the eligibility criteria was selected through simple random sampling on the respective clinic days of the cancer treatment centre and urology clinic. Data was collected through a pre-tested structured questionnaire and HRQoL tools which are EORTC-QLQ-C30 and EORTC-QLQ-PR25 and analysed using STATA version 13 software. Descriptive analysis was used to summarise the continuous and categorical variables. Spearman's rho (rs) correlation was used to determine the predictors of HRQoL based on the strength and significance of association at 0.05 level of significance. RESULTS The mean age of the participants was 70.5 (±7.35) years. The majority (52, 83.9%) of the patients had a prostate specific antigen (PSA) above 20 ng/ml. Twenty-one (33.9%) were graded as Gleason group 5 and 41 (66.1%) had stage IV disease at diagnosis. Fifty (80.9%) participants were on hormonal therapy, with most of them being on combined androgen blockade. The overall HRQoL was 65.1. Fatigue, one of the major complaints among these patients, was negatively associated with physical functioning (p = 0.0005), role functioning (p = 0.0026), social functioning (p = 0.0001), financial difficulties (p = 0.0077) and quality of life (p = 0.0050). CONCLUSION Fatigue was the most common predictor of poor HRQoL in several scales of measurement. For those on management, frequent assessment of HRQoL should be carried out and interventions instituted immediately.
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Affiliation(s)
| | - Peter N Karimi
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Irene W Weru
- Pharmacy Division, Kenyatta National Hospital, Nairobi, Kenya
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Bera S, Kadkol S, Hong LK, Ali W, Brockman JD, Sverdlov M, Brister E, Macais V, Kajdacsy-Balla A, Valyi-Nagy K, Xu Z, Kastrati I, Liu L, Diamond AM. Regulation of SELENOF translation by eIF4a3: Possible role in prostate cancer progression. Mol Carcinog 2023; 62:1803-1816. [PMID: 37555760 DOI: 10.1002/mc.23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023]
Abstract
The levels of the SELENOF selenoprotein are dramatically reduced in prostate cancer compared to adjacent benign tissue and reducing SELENOF in prostate epithelial cells results in the acquisition of features of the transformed phenotype. It was hypothesized that the aberrant increase in the eiF4a3 translation factor, which has an established role in RNA splicing and the regulation of selenoprotein translation, contributes to the lower levels of SELENOF. Using the available databases, eIF4a3 messenger RNA (mRNA) levels are elevated in prostate cancer compared to normal tissue as is the hypomethylation of the corresponding gene. Using a prostate cancer tissue microarray, we established that eiF4a3 levels are higher in prostate cancer tissue. Ectopic expression of eIF4a3 in prostate cancer cells reduced SELENOF levels and attenuated the readthrough of the UGA codon using a specialized reporter construct designed to examine UGA decoding, with the opposite effects observed using eIF4a3 knock-down constructs. Direct binding of eIF4a3 to the regulatory regions of SELENOF mRNA was established with pull-down experiments. Lastly, we show that an eIF4a3 inhibitor, eIF4a3-IN-2, increases SELENOF levels, UGA readthrough, and reduces binding of eIF4a3 to the SELENOF mRNA 3'-UTR in exposed cells. These data establish eIF4a3 as a likely prostate cancer oncogene and a regulator of SELENOF translation.
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Affiliation(s)
- Soumen Bera
- Department of Pathology, Chicago, Illinois, USA
- School of Life Sciences, B.S.Abdur Rahman Crescent Institute of Science and Technology, Chennai, Tamil Nadu, India
| | | | | | - Waleed Ali
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - John D Brockman
- Department of Chemistry, University of Missouri Research Reactor, Columbia, Missouri, USA
| | - Maria Sverdlov
- Department of Pathology, Chicago, Illinois, USA
- Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | | | | | - Ziqiao Xu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irida Kastrati
- Departments of Cancer Biology and Pathology & Laboratory Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Carbunaru S, Sun Z, McCall C, Ofori B, Marshall N, Wang H, Abern M, Liu L, Hollowell CMP, Sharifi R, Vidal P, Kajdacsy‐Balla A, Sekosan M, Ferrer K, Wu S, Gallegos M, Gann PH, Moreira D, Sharp LK, Ferrans CE, Murphy AB. Impact of genomic testing on urologists' treatment preference in favorable risk prostate cancer: A randomized trial. Cancer Med 2023; 12:19690-19700. [PMID: 37787097 PMCID: PMC10587942 DOI: 10.1002/cam4.6615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION The Oncotype Dx Genomic Prostate Score (GPS) is a 17-gene relative expression assay that predicts adverse pathology at prostatectomy. We conducted a novel randomized controlled trial to assess the impact of GPS on urologist's treatment preference for favorable risk prostate cancer (PCa): active surveillance versus active treatment (i.e., prostatectomy/radiation). This is a secondary endpoint from the ENACT trial which recruited from three Chicago hospitals from 2016 to 2019. METHODS Ten urologists along with men with very low to favorable-intermediate risk PCa were included in the study. Participants were randomly assigned to standardized counseling with or without GPS assay. The main outcome was urologists' preference for active treatment at Visit 2 by study arm (GPS versus Control). Multivariable best-fit binary logistic regressions were constructed to identify factors independently associated with urologists' treatment preference. RESULTS Two hundred men (70% Black) were randomly assigned to either the Control (96) or GPS arm (104). At Visit 2, urologists' preference for prostatectomy/radiation almost doubled in the GPS arm to 29.3% (29) compared to 14.1% (13) in the Control arm (p = 0.01). Randomization to the GPS arm, intermediate NCCN risk level, and lower patient health literacy were predictors for urologists' preference for active treatment. DISCUSSION Limitations included sample size and number of urologists. In this study, we found that GPS testing reduced urologists' likelihood to prefer active surveillance. CONCLUSIONS These findings demonstrate how obtaining prognostic biomarkers that predict negative outcomes before treatment decision-making might influence urologists' preference for recommending aggressive therapy in men eligible for active surveillance.
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Affiliation(s)
- Samuel Carbunaru
- Department of UrologyNew York University Langone School of MedicineNew YorkNew YorkUSA
| | - Zequn Sun
- Department of Preventive MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Cordero McCall
- Medical College of Wisconsin Medical SchoolMilwaukeeWisconsinUSA
| | - Bernice Ofori
- Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
| | - Norma Marshall
- Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
| | - Heidy Wang
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Michael Abern
- Division of UrologyDuke UniversityDurhamNorth CarolinaUSA
| | - Li Liu
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | | | | | | | - Marin Sekosan
- Department of PathologyCook County Health and Hospital SystemChicagoIllinoisUSA
| | - Karen Ferrer
- Department of PathologyCook County Health and Hospital SystemChicagoIllinoisUSA
| | - Shoujin Wu
- Pathology and Laboratory ServicesJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Marlene Gallegos
- Pathology and Laboratory ServicesJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Peter H. Gann
- Department of PathologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Daniel Moreira
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Lisa K. Sharp
- Institute for Health Research and PolicyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Carol E. Ferrans
- Department of Biobehavioral Nursing ScienceUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Adam B. Murphy
- Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
- Division of UrologyCook County HealthChicagoIllinoisUSA
- Division of UrologyJesse Brown VA Medical CenterChicagoIllinoisUSA
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Jani C, Mouchati C, Abdallah N, Mariano M, Jani R, Salciccioli JD, Marshall DC, Singh H, Sheng I, Shalhoub J, McKay RR. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database. Prostate Cancer Prostatic Dis 2023; 26:552-562. [PMID: 36522462 DOI: 10.1038/s41391-022-00628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States of America (USA), prostate cancer (PC) is the most common cancer in men and the second cause of cancer mortality. Black men (BM) have a higher incidence and worse mortality when compared to white men (WM). We compared trends in PC mortality in the USA by race and state from 1999 to 2019. METHODS We extracted PC mortality data from the Centers for Disease Control (CDC) WONDER database using the International Classification of Diseases (ICD) 10 code C61. Age-Standardized Mortality Rates (ASMR) were divided into racial groups and reported by year and state. Due to the lack of available data in many states, analyses were conducted only for WM and BM using Joinpoint regression for trend comparisons. RESULTS Between 1999-2019, ASMR decreased at the national level in Black (-44.6%), Asian (-44.8%), White (-31.8%), and American Indian or Alaskan native men (-19.0%). ASMR decreased in all states for both races. The greatest drop in ASMR was in Kentucky (-47.0%) for WM and Delaware (-57.8%) for BM. In 2019, ASMRs in BM (13.4/100 000) were significantly higher than WM (7.3/100 000), American Indian or Alaskan Native (3.2/100 000), and Asian men (3.2/100 000) (p < 0.001). The highest ASMRs were in Nebraska (33.5/100 000) for BM and Alaska (11/100 000) for WM. CONCLUSIONS During the last 20 years, the PC mortality rate dropped in all states for all races, suggesting an advancement in management strategies. Although a higher decrease in ASMR was observed in BM, ASMR remain higher among BM. ASMRs were also found to be increasing in many states post USPSTF guideline change (2012), indicating a need for more education around optimized prostate cancer screening.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christian Mouchati
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ruchi Jani
- Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Justin D Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Dominic C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harpreet Singh
- Division of Pulmonary and Critical Care, University of Wisconsin, Milwaukee, WI, USA
| | - Iris Sheng
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Hematology and Oncology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rana R McKay
- University of California San Diego, San Diego, CA, 2021, USA
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Mensah J, Amoah Y, Ofori E, Verna Vanderpuye MA. Determinants of Mortality among Patients Managed for Prostate Cancer: Experience from Korle Bu Teaching Hospital in Ghana. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:65-70. [PMID: 37538217 PMCID: PMC10395851 DOI: 10.4103/jwas.jwas_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 08/05/2023]
Abstract
Background Over the past two decades, diagnosis and treatment approaches for men with prostate cancer have changed dramatically, with improvements in established prostate cancer treatments and new treatment strategies. However, In sub-Saharan African countries, there is a paucity of data on the characteristics and treatment of men who eventually die from Prostate Cancer (PCa). We used the clinical records of patients who died from PCa to describe the natural history and treatment PCa patients in Ghana. Methods From 2013 to 2022, the medical records of 234 men who died of PCa at a tertiary hospital in Ghana were prospectively collected and retrospectively analysed. Results The mean age at death was 71.6 years, and the median was 72.5 years. 51.3% died within 24 months of diagnosis, 23.0% between 2 and 5 years after diagnosis, and a quarter survived for more than 5 years. Over 80% presented with advanced disease, characterised by high prostate-specific antigen (PSA) levels, a high T stage on DRE, and evidence of metastasis. 43.6% presented with haemoglobin levels below 10ng/dl at diagnosis. These patients had the worst outcome, with 73% dying less than 2 years after diagnosis. The 5-yr survival rate of patients who presented with metastatic disease was 21.2 %. Over 80% were treated with bilateral total orchidectomy, with less than 10% receiving treatment intensification with the newer generation antiandrogens or chemotherapy. Conclusion Our analysis shows that patients who die from PCa have aggressive disease, are diagnosed at an advanced stage, and are relatively younger than in Western countries. There is also a slow uptake of newer treatment strategies for metastatic prostate cancer. These results confirm literature suggesting that blacks have poorer outcomes due to the disease's aggressive nature. Further research is needed to understand the mechanisms and also define appropriate management for metastatic PCa in sub-Saharan Africa.
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Affiliation(s)
- James Mensah
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Yaw Amoah
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Emanuele Ofori
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
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Briggs LG, Steele GL, Qian ZJ, Subbana S, Alkhatib KY, Labban M, Langbein BJ, Nguyen DD, Cellini J, Kilbridge K, Kibel AS, Trinh QD, Rana HQ, Cole AP. Racial Differences in Germline Genetic Testing for Prostate Cancer: A Systematic Review. JCO Oncol Pract 2023; 19:e784-e793. [PMID: 36649495 DOI: 10.1200/op.22.00634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Testing for pathogenic variants can aid in oncologic risk stratification and identification of targeted therapies. Despite known disparities in access to prostate cancer (PCa) care, little has been written about access to germline genetic testing (GGT) for Black men and other historically marginalized populations. This systematic review sought to delineate racial/ethnic disparities in GGT for PCa. METHODS This systematic review identified articles published from January 1996 through May 2021 in PubMed, Web of Science, and Embase. We included studies that reported rates of GGT in men with PCa in the United States by race/ethnicity as reflective of routine clinical care or research. A narrative synthesis was performed. RESULTS Of 4,309 unique records, 91 studies examining 50 unique study populations met inclusion criteria. Of these, four populations included men who received GGT through routine clinical care, accounting for 4,415 men (72.6% White and 7.2% Black). The other 46 populations included men who received GGT as part of a research study, accounting for 30,824 men (64.3% White and 21.6% Black). Of these 46 research populations, 19 used targeted methods to increase recruitment from a specific demographic. CONCLUSION Most studies that report GGT rates by race/ethnicity are in research settings. Many of these studies used targeted recruitment methods and subsequently have a greater proportion of Black men than clinical and US population-based studies. Other historically marginalized populations are not well represented. There remains a knowledge gap regarding the extent of racial disparities in the use of GGT, particularly in the clinical setting.
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Affiliation(s)
- Logan G Briggs
- Department of Urologic Surgery, Mayo Clinic, Phoenix, AZ.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Grant L Steele
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Zhiyu Jason Qian
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Khalid Y Alkhatib
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Muhieddine Labban
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bjoern J Langbein
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Kerry Kilbridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Huma Q Rana
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Alexander P Cole
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
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10
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Pincus J, Greenberg JW, Natale C, Koller CR, Miller S, Silberstein JL, Krane LS. Five-Year Prospective Observational Study of African-American Men on Active Surveillance for Prostate Cancer Demonstrates Race Is Not Predictive of Oncologic Outcomes. Oncologist 2022; 28:149-156. [PMID: 35920550 PMCID: PMC9907040 DOI: 10.1093/oncolo/oyac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/24/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate if race impacted outcomes or risk of disease progression in men on active surveillance (AS) for prostate cancer. We present the results from our majority African-American cohort of men in an equal access setting over a 5-year follow-up period. PATIENTS AND METHODS All patients who elected AS for prostate cancer at the Southeast Louisiana Veterans Health Care System are entered into a prospectively managed observational database. Patients were divided into groups based on self-reported race. Grade group progression was defined as pathologic upgrading above International Society of Urological Pathology Grade Group 1 disease on subsequent biopsies following diagnostic biopsy. All tests were 2 sided using a significance of .05. RESULTS A total of 228 men met inclusion criteria in the study, including 154 non-Hispanic African American and 74 non-Hispanic Caucasian American men, with a median follow-up of 5 years from the initiation of AS. Race was not predictive of Gleason grade progression, AS discontinuation, or biochemical recurrence on Cox multivariate analysis (HR = 1.01, 0.94, 0.85, P = .96, .79, .81, respectively). On Kaplan-Meier analysis at 5 years, African-American progression-free, AS discontinuation free, and overall survival probability was comparable to their Caucasian American counterparts (P > .05 for all). CONCLUSIONS Active surveillance is a safe treatment option for low and very low risk prostate cancer, regardless of race. African-American and Caucasian-American men did not have any significant difference in Gleason grade group progression in our cohort with 5-year follow-up.
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Affiliation(s)
| | | | - Caleb Natale
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Christopher R Koller
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Stephanie Miller
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | | | - L Spencer Krane
- Corresponding author: L. Spencer Krane, MD, Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA 70119, USA. Tel: +1 504 988 2750; Fax: +1 504 988 5059;
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11
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de la Calle CM, Bhanji Y, Pavlovich CP, Isaacs WB. The role of genetic testing in prostate cancer screening, diagnosis, and treatment. Curr Opin Oncol 2022; 34:212-218. [PMID: 35238838 DOI: 10.1097/cco.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of the current role of genetic testing in prostate cancer screening, diagnosis, and treatment. RECENT FINDINGS Recent studies have uncovered few but highly penetrant rare pathogenic mutations (RPMs), in genes, such as BRCA2, with strong prostate cancer risk and outcomes associations. Over 260 single nucleotide polymorphisms (SNPs) have also been identified, each associated with small incremental prostate cancer risk and when combined in a polygenic risk score (PRS), they provide strong prostate cancer risk prediction but do not seem to predict outcomes. Tumor tissue sequencing can also help identify actionable somatic mutations in many patients with advanced prostate cancer and inform on their risk of harboring a germline pathogenic mutation. SUMMARY RPM testing, PRS testing, and tumor sequencing all have current and/or potential future roles in personalized prostate cancer care.
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Affiliation(s)
- Claire M de la Calle
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Impact of diverticular disease on prostate cancer risk among hypertensive men. Prostate Cancer Prostatic Dis 2022; 25:700-706. [PMID: 34621012 DOI: 10.1038/s41391-021-00454-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Prostate cancer (PCa) is a heterogenous disease with multiple etiological factors playing a role in its development. Recently, chronic and systemic inflammatory conditions such as inflammatory bowel disease were identified as key risk factors influencing its development. The study aimed to evaluate the relationship between diverticular disease (DD) (local and acute inflammation) and PCa. METHODS Hypertensive patients with DD and hypertensive controls were identified between 1995 and 2010 from the Statewide Planning and Research Cooperative System database. Cohorts were queried for PCa incidence through 2015. Univariable and multivariable logistic regression analyses were used for determining independent predictors of PCa diagnosis. RESULTS A total of 51,353 patients with DD and 111,541 controls were identified. In all, 6.26% of DD developed PCa, and 3.71% of controls developed PCa (p < 0.01). DD was a significant risk factor for PCa (OR: 1.27 CI: 1.19-1.34, p < 0.01). On subgroup analysis, the patients diagnosed with DD <50 years old had an OR of 3.39 for PCa (CI: 2.52-4.56, p < 0.01), age 50-59 had an OR of 2.12 (CI: 1.86-2.15, p < 0.01), and age 60-69 had an OR of 1.20 (CI: 1.10-1.31, p < 0.01). Finally, age and race stratification showed that white patients <50 had an OR of 2.56 (CI: 1.75-3.76, p < 0.01), while black patients <50 had an OR of 3.98 (CI: 2.61-6.07, p < 0.01). The trend in differing odds between these populations was the same for age groups 50-59 and 60-69. CONCLUSION Our analysis shows that DD is associated with diagnosis of PCa in hypertensive men. Importantly, the earlier the diagnosis of DD, the higher the odds for development of PCa, particularly in black men.
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13
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Hybrid algorithm for the classification of prostate cancer patients of the MCC-Spain study based on support vector machines and genetic algorithms. Neurocomputing 2021. [DOI: 10.1016/j.neucom.2019.08.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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14
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Mahal BA, Gerke T, Awasthi S, Soule HR, Simons JW, Miyahira A, Halabi S, George D, Platz EA, Mucci L, Yamoah K. Prostate Cancer Racial Disparities: A Systematic Review by the Prostate Cancer Foundation Panel. Eur Urol Oncol 2021; 5:18-29. [PMID: 34446369 DOI: 10.1016/j.euo.2021.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Prostate cancer (PCa) is a complex disease that disproportionately impacts Black men in the USA. The structural factors that drive heterogeneous outcomes for patients of differing backgrounds are probably the same ones that result in population-level disparities. The relative contribution of drivers along the PCa disease continuum is an active area of investigation and debate. OBJECTIVE To critically synthesize the available evidence on PCa disparities from a population-level perspective in comparison to data from "equal access and equal care settings" and to provide a consensus summary of the state of PCa disparities. EVIDENCE ACQUISITION A plenary panel on PCa disparities presented at the Prostate Cancer Foundation meeting on October 24, 2019 and ensuing discussions are reported here. We used a systematic literature review approach and the Preferred Reporting Items for Systematic Reviews and Meta-analyses to select the most relevant publications. A total of 3333 publications between 2011 and 2021 were retrieved, of which 52 were included in the review; an additional 13 articles on screening guidelines, seminal clinical trials, and statistical methodology were used in the evidence synthesis. EVIDENCE SYNTHESIS Race disparities in PCa are a result of a complex interaction between socioeconomic factors impacting access to care and ancestral/genetic factors that may influence tumor biology. Black men in the USA continue to have a nearly 1.8 times higher population-level mortality rate than White men. Failure to account for the race-specific incidence burden would continue to lead to residual disparity even after achieving relatively similar outcomes after primary treatment, resulting in a higher long-term mortality burden. Selection bias remains possible in PCa studies, which often rely on highly specific cohorts of Black men with higher use of health care resources that may not represent the average Black patient in the USA. Novel methods including mediation analysis and genetic ancestry rather than self-identified race can optimize analytical models investigating racial disparities and may lead to a better understanding of PCa genomic diversity and behavior. CONCLUSIONS Our findings emphasize the importance of racially diverse studies, including precision -omics, prevention, and targeted therapy initiatives, to elucidate mechanisms underlying racial differences in outcomes and response to therapy. We propose novel approaches for studying and addressing PCa disparities. Contemporary methods, particularly in the domain of mediation analysis, can promote scientific rigor in understanding these disparities. PATIENT SUMMARY Inaccurate data interpretation or lack of data altogether for Black men can impact policy and ultimately affect millions of individuals of African origin worldwide. Our review identifies a need to develop and prioritize a strategy for including Black and other men with prostate cancer in intervention studies and randomized clinical trials to halt the widening prostate cancer disparities.
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Affiliation(s)
- Brandon A Mahal
- Dana-Farber Cancer Institute, Boston, MA, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Travis Gerke
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | | | | | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Daniel George
- Divisions of Medical Oncology and Urology, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Lorelei Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kosj Yamoah
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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15
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Carbunaru S, Stinson J, Babajide R, Hollowell CMP, Yang X, Sekosan M, Ferrer K, Kajdacsy‐Balla A, Abelleira J, Ruden M, King‐Lee P, Dalton DP, Casalino DD, Kittles RA, Gann PH, Schaeffer EM, Murphy AB. Performance of prostate health index and PSA density in a diverse biopsy‐naïve cohort with mpMRI for detecting significant prostate cancer. BJUI COMPASS 2021; 2:370-376. [PMID: 35474697 PMCID: PMC8988695 DOI: 10.1002/bco2.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 01/11/2023] Open
Abstract
Objective To compare Prostate Health Index (PHI) and prostate‐specific antigen (PSA) density as secondary tests after multiparametric magnetic resonance imaging (mpMRI) in improving the detection accuracy of Gleason grade group (GG) 2‐5 prostate cancer (PCa) and in decreasing unnecessary biopsies in a multiethnic biopsy‐naïve population. Methods From February 2017 to February 2020, we recruited consecutive biopsy‐naïve men in participating urology clinics for elevated PSA levels. They all had a PHI score, mpMRI, and prostate biopsy. Experienced genitourinary radiologists read all mpMRI studies based on PIRADS version 2.0. Logistic regression models were used to generate receiver operating characteristic curves. Models were tested for effect modification between Race (Black vs White) and both PHI and PSA density, and Race and PIRADS to determine if race impacted their prediction accuracy. Sensitivity, specificity, and predictive values of PHI and PSA density thresholds were calculated by PIRADS scores. The primary outcome was GG2‐5 PCa, that is, Gleason score ≥3 + 4. Results The study included 143 men, of which 65 (45.5%) were self‐reported Black. Median age was 62.0 years and 55 men (38.4%) had GG2‐5 PCa. Overall, 18.1% had PIRADS 1‐2, 32.9% had PIRADS 3, and 49.0% had PIRADS 4‐5. For the binary logistic regressions, the interactions between PIRADS and Race (P = .08), Log (PHI) and Race (P = .17), and Log (PSA density) and Race (P = .42) were not statistically significant. Within PIRADS 3 lesions, a PHI ≥49 prevented unnecessary biopsies in 55% of men and missed no GG2‐5 PCa, yielding a negative predictive value of 100%. There was no reliable PHI or PSA density threshold to avoid PCa biopsies in PIRADS 1‐2 or 4‐5. Conclusions PHI and PSA density can be used after mpMRI to improve the detection of GG2‐5 PCa in a biopsy‐naïve cohort. PHI may be superior to PSA density in PIRADS 3 lesions by avoiding 55% of unnecessary biopsies. Using both PHI and PSA density in series may further increase specificity and lead to fewer unnecessary biopsies, but further larger studies are warranted to determine the optimal threshold of each biomarker.
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Affiliation(s)
- Samuel Carbunaru
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - James Stinson
- Division of Urology Cook County Health and Hospitals System Chicago IL USA
| | - Rilwan Babajide
- Pritzker School of Medicine University of Chicago Chicago IL USA
| | | | - Ximing Yang
- Department of Pathology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Marin Sekosan
- Department of Pathology & Laboratory Medicine Cook County Health and Hospitals System Chicago IL USA
| | - Karen Ferrer
- Department of Pathology & Laboratory Medicine Cook County Health and Hospitals System Chicago IL USA
| | | | - Josephine Abelleira
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Maria Ruden
- Division of Urology Cook County Health and Hospitals System Chicago IL USA
| | - Patrice King‐Lee
- Department of Pathology University of Illinois at Chicago Chicago IL USA
| | - Daniel P. Dalton
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David D. Casalino
- Department of Pathology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Rick A. Kittles
- Department of Population Sciences City of Hope Duarte CA USA
| | - Peter H. Gann
- Department of Pathology University of Illinois at Chicago Chicago IL USA
| | - Edward M. Schaeffer
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Adam B. Murphy
- Department of Urology Northwestern University Feinberg School of Medicine Chicago IL USA
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16
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Smith KER, Brown JT, Wan L, Liu Y, Russler G, Yantorni L, Caulfield S, Lafollette J, Moore M, Kucuk O, Carthon B, Nazha B, Bilen MA. Clinical Outcomes and Racial Disparities in Metastatic Hormone-Sensitive Prostate Cancer in the Era of Novel Treatment Options. Oncologist 2021; 26:956-964. [PMID: 34096667 DOI: 10.1002/onco.13848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Docetaxel (DOC) and abiraterone (ABI) in the upfront setting have separately improved clinical outcomes for metastatic hormone-sensitive prostate cancer (mHSPC), but there are no studies comparing drug efficacies or the influence of racial disparities. MATERIALS AND METHODS We performed a retrospective multicenter review from Winship Cancer Institute at Emory University and Georgia Cancer Center for Excellence at Grady Memorial Hospital (2014-2020) for patients with mHSPC treated with either upfront DOC or ABI. Outcomes evaluated were overall survival (OS), progression-free survival (PFS), and prostate-specific antigen complete response (PSA CR). RESULTS A total of 168 patients were included, consisting of 92 (54.8%) Black patients and 76 (45.2%) non-Black patients (69 White and 7 Asian or Hispanic). Ninety-four (56%) received DOC and 74 (44%) received ABI. Median follow-up time was 22.8 months with data last reviewed June 2020. For OS, there was no significant difference between ABI versus DOC and Black versus non-Black patients. For PFS, DOC was associated with hazard ratio (HR) 1.7 compared with ABI for all patients based on univariate association and HR 2.27 compared with ABI for Black patients on multivariable analysis. For PSA CR, Black patients were less likely to have a CR (odds ratio [OR] = 0.27). CONCLUSION ABI and DOC have similar OS with a trend toward better PFS for ABI in a cohort composed of 54% Black patients. Racial disparities were observed as prolonged PFS for Black patients treated with ABI, more so compared with all patients, and less PSA CR for Black patients. A prospective trial comparing available upfront therapies in a diverse racial population is needed to help guide clinical decision-making in the era of novel treatment options. IMPLICATIONS FOR PRACTICE Overall survival is similar for abiraterone and docetaxel when used as upfront therapy in metastatic hormone-sensitive prostate cancer in a cohort composed of 54% Black patients. There is a trend towards improved progression-free survival for abiraterone in all patients and Black patients. Non-Black patients were more likely to achieve prostate-specific antigen (PSA) complete response regardless of upfront therapy.
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Affiliation(s)
| | - Jacqueline Theresa Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Limeng Wan
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Greta Russler
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jennifer Lafollette
- Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Melvin Moore
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bradley Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
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17
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Wang J, Xia HHX, Zhang Y, Zhang L. Trends in treatments for prostate cancer in the United States, 2010-2015. Am J Cancer Res 2021; 11:2351-2368. [PMID: 34094691 PMCID: PMC8167696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 02/07/2023] Open
Abstract
Although annual mortality trends for prostate cancer were stabilized in recent years, understanding the exact treatment changes is necessary for optimal management. Utilization of not-otherwise specified (NOS) treatments for prostate cancer was unclear. Thus, this study aimed to analyze trends in treatment for prostate cancer in the U.S. from 2010 to 2015 and examine whether the treatment for the prostate cancer in the U.S. is compliant with clinical practice guidelines. Using joinpoint regression models, we examined trends in the rate and proportion of age-standardized utilization (ASUR and ASUP) of treatments for prostate cancer diagnosed during 2010-2015 in the U.S. based on the data from the Surveillance, Epidemiology, and End Results (SEER, 2018 data-release, with linkage to active surveillance/watchful waiting [AS/WW]) cancer registry program. Among 316,690 men with prostate cancer diagnosed during 2010-2015, ASUR and ASUP for radical prostatectomy, radiotherapy, AS/WW and NOS treatment were 32.7, 34.4, 10.0 and 40.1 per 100,000, and 27.9%, 29.3%, 8.5% and 34.2%, respectively. Trends in the overall ASUR for prostate cancer treatments differed by cancer risk group, patients' age, race/ethnicity, Gleason score, insurance status, and the average education level, average poverty-level and foreign-born person percentage of the patient's residence-county, but not by rural-urban continuum or region. ASUP of radical prostatectomy decreased from 9.8% in 2010 to 4.8% in 2015 (annual percent change [APC] = -12.0%, 95% CI, -15.9 to -7.9%), and the decrease was observed in all different risk groups. ASUP of AS/WW increased from 16.4% in 2010 to 30.2% in 2013 (APC = 22.7%, 95% CI, 4.6 to 44.0%) and then remained stable through 2013 to 2015 (APC = 1.9%, 95% CI, -24.1 to 36.9%). The increasing tendency of AS/WW only occurred in the low-risk and intermediate-risk groups. The ASUP of NOS treatment has increased from 32.3% in 2010 to 36.8% in 2015 (P<0.01). In conclusion, ASUR and ASUP for prostate cancer treatments, including NOS treatment, had changed during 2010-2015. Their trends appeared to differ by cancer risk-group, age, race/ethnicity, Gleason score and socioeconomic factors. Future studies are warranted to understand the impacts of upward trends in ASUP of NOS treatments and AS/WW on patient survival and prostate cancer mortality.
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Affiliation(s)
- Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityBeijing, China
| | - Harry Hua-Xiang Xia
- Department of Gastroenterology, First Affiliated Hospital, Guangdong Pharmaceutical UniversityGuangzhou, China
| | - Yuanyuan Zhang
- Department of Pharmacology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, China
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical CenterPlainsboro, NJ, USA
- Department of Biological Sciences, Rutgers UniversityNewark, NJ, USA
- Rutgers Cancer Institute of New JerseyNew Brunswick, NJ, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ, USA
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18
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Babajide R, Carbunaru S, Nettey OS, Watson KS, Holloway-Beth A, McDowell T, Levi JB, Murray M, Stinson J, Hollowell CMP, Dalton DP, Moore L, Kittles RA, Gann PH, Schaeffer EM, Murphy AB. Performance of Prostate Health Index in Biopsy Naïve Black Men. J Urol 2021; 205:718-724. [PMID: 33103942 PMCID: PMC8320068 DOI: 10.1097/ju.0000000000001453] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE The Prostate Health Index is validated for prostate cancer detection but has not been well validated for Gleason grade group 2-5 prostate cancer detection in Black men. We hypothesize that the Prostate Health Index has greater accuracy than prostate specific antigen for detection of Gleason grade group 2-5 prostate cancer. We estimated probability of overall and Gleason grade group 2-5 prostate cancer across previously established Prostate Health Index ranges and identified Prostate Health Index cutoffs that maximize specificity for Gleason grade group 2-5 prostate cancer with sensitivity >90%. MATERIALS AND METHODS We recruited a "cancer-free" Black control cohort (135 patients) and a cohort of biopsy naïve Black men (158) biopsied for elevated prostate specific antigen. Descriptive statistics compared the prostate cancer cases and controls and the frequency of Gleason grade group 2-5 prostate cancer across Prostate Health Index scores. Receiver operating characteristics compared the discrimination of prostate specific antigen, Prostate Health Index and other prostate specific antigen related biomarkers. Sensitivity and specificity for Gleason grade group 2-5 prostate cancer detection were assessed at prostate specific antigen and Prostate Health Index thresholds alone and in series. RESULTS Of biopsied subjects 32.9% had Gleason grade group 2-5 prostate cancer. In Blacks with prostate specific antigen from 4.0-10.0 ng/ml, Prostate Health Index and prostate specific antigen had similar discrimination for Gleason grade group 2-5 prostate cancer (0.63 vs 0.57, p=0.27). In Blacks with prostate specific antigen ≤10.0, a threshold of prostate specific antigen ≥4.0 had 90.4% sensitivity for Gleason grade group 2-5 prostate cancer; a threshold of prostate specific antigen ≥4.0 with Prostate Health Index ≥35.0 in series avoided unnecessary biopsy in 33.0% of men but missed 17.3% of Gleason grade group 2-5 prostate cancer. Prostate specific antigen ≥4.0 with Prostate Health Index ≥28.0 in series spared biopsy in 17.9%, while maintaining 90.4% sensitivity of Gleason grade group 2-5 prostate cancer. CONCLUSIONS The Prostate Health Index has moderate accuracy in detecting Gleason grade group 2-5 prostate cancer in Blacks, but Prostate Health Index ≥28.0 can be safely used to avoid some unnecessary biopsies in Blacks.
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Affiliation(s)
- Rilwan Babajide
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | | | | | - Karriem S. Watson
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | - Alfreda Holloway-Beth
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | | | - Josef Ben Levi
- Department of Philosophy/Educational Inquiry and Curriculum Studies, Northeastern Illinois University, Chicago, Illinois
| | | | - James Stinson
- Division of Urology, Cook County Health and Hospitals System, Chicago, Illinois
| | | | - Daniel P. Dalton
- Department of Urology, Northwestern Medicine, UroPartners, Northwestern Medicine, Chicago, Illinois
| | | | - Rick A. Kittles
- Department of Population Sciences, City of Hope, Duarte, California
| | - Peter H. Gann
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | | | - Adam B. Murphy
- Department of Urology, Northwestern Medicine, Chicago, Illinois
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Oczkowski M, Dziendzikowska K, Pasternak-Winiarska A, Włodarek D, Gromadzka-Ostrowska J. Dietary Factors and Prostate Cancer Development, Progression, and Reduction. Nutrients 2021; 13:nu13020496. [PMID: 33546190 PMCID: PMC7913227 DOI: 10.3390/nu13020496] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/24/2022] Open
Abstract
Due to the constantly increasing number of cases, prostate cancer has become one of the most important health problems of modern societies. This review presents the current knowledge regarding the role of nutrients and foodstuff consumption in the etiology and development of prostate malignancies, including the potential mechanisms of action. The results of several in vivo and in vitro laboratory experiments as well as those reported by the clinical and epidemiological research studies carried out around the world were analyzed. The outcomes of these studies clearly show the influence of both nutrients and food products on the etiology and prevention of prostate cancer. Consumption of certain nutrients (saturated and trans fatty acids) and food products (e.g., processed meat products) leads to the disruption of prostate hormonal regulation, induction of oxidative stress and inflammation, and alteration of growth factor signaling and lipid metabolism, which all contribute to prostate carcinogenesis. On the other hand, a high consumption of vegetables, fruits, fish, and whole grain products exerts protective and/or therapeutic effects. Special bioactive functions are assigned to compounds such as flavonoids, stilbenes, and lycopene. Since the influence of nutrients and dietary pattern is a modifiable risk factor in the development and prevention of prostate cancer, awareness of the beneficial and harmful effects of individual food ingredients is of great importance in the global strategy against prostate cancer.
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Family history of prostate cancer and prostate tumor aggressiveness in black and non-black men;results from an equal access biopsy study. Cancer Causes Control 2021; 32:337-346. [PMID: 33532986 PMCID: PMC7946692 DOI: 10.1007/s10552-020-01389-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Purpose To test for racial differences in associations between family history (FH) of prostate cancer (PC) and prostate cancer aggressiveness in a racially diverse equal access population undergoing prostate biopsy. Subjects/patients and methods We prospectively enrolled men undergoing prostate biopsy at the Durham Veterans Administration from 2007 to 2018 and assigned case or control status based on biopsy results. Race and FH of PC were self-reported on questionnaires. Logistic regression was used to test the association between FH and PC diagnosis overall and by tumor aggressiveness [high- (Grade Group 3–5) or low-grade (Grade Group 1–2) vs. no cancer], overall, and stratified by race. Models were adjusted for age and year of consent, race, PSA level, digital rectal exam findings, prostate volume, and previous (negative) biopsy receipt. Results Of 1,225 men, 323 had a FH of PC and 652 men were diagnosed with PC on biopsy. On multivariable analysis, FH was associated with increased odds of high-grade PC in black (OR 1.85, p = 0.041) and all men (OR 1.56, p = 0.057) and was unrelated to overall or low-grade PC diagnosis, overall, or stratified by race (all p ≥ 0.325). In sensitivity analyses among men without a previous biopsy, results were slightly more pronounced. Conclusion In this setting of equal access to care, positive FH of PC was associated with increased tumor aggressiveness in black men, but not non-black men undergoing prostate biopsy. Further research is required to tease apart the contribution of genetics from increased PC awareness potentially influencing screening and biopsy rates in men with FH. Supplementary Information The online version of this article (10.1007/s10552-020-01389-8) contains supplementary material, which is available to authorized users.
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Dickey SL, Matthews C, Millender E. An Exploration of Precancer and Post-Cancer Diagnosis and Health Communication Among African American Prostate Cancer Survivors and Their Families. Am J Mens Health 2020; 14:1557988320927202. [PMID: 32452292 PMCID: PMC7252380 DOI: 10.1177/1557988320927202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer is the second most common cancer among American men, with Black men at the highest risk for the disease. Few studies have been published on how communication between Black prostate cancer survivors and their family members affect health outcomes and subsequent health communication. The purpose of this study was to understand cancer and health communication among Black prostate cancer survivors and their families before and after disclosing their diagnosis. Through a mixed method design, 11 Black prostate cancer survivors participated from the Southeastern region of the United States, completed questionnaires, and took part in a focus group. The study utilized 4 focus groups of Black prostate cancer survivors ranging in age from 51 to 76 years. Descriptive statistics revealed 91% (n = 10) of participants indicated they could openly discuss health issues in their family and 82% (n = 9) indicated a female relative as the person responsible for teaching about health. An analysis of the transcripts revealed four themes utilizing thematic network: (a) communication over the life course of the prostate cancer survivor, (b) parents’ communication with family, (c) disclosing prostate cancer diagnosis, and (d) treatment options for prostate cancer. Results suggested the participants recognized the importance of discussing prostate cancer with their families to reduce fears and misconceptions about the disease. Through the exploration of cancer and health communication within Black families, solutions can be derived for increasing health behaviors and health knowledge among men.
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Watson K, Buscemi J, Fitzgibbon M, Murray M, Murphy A, Abern M, Gann P, Levi JB, Stinson J, Diefenbach M, Winn RA. Society of Behavior Medicine (SBM) Urges Congress to Ensure Affordable Care Act Coverage of Prostate Cancer Screening Support Services for High-Risk Men. Transl Behav Med 2020; 10:492-494. [PMID: 30855080 PMCID: PMC7237538 DOI: 10.1093/tbm/ibz034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prostate cancer (PCa) disproportionately affects African American men. Early detection reduces risk of mortality. The United States Preventive Services Task Force (USPSTF) issued an updated recommendation statement on serum Prostate Specific Antigen (PSA)-based screening for PCa. Specifically, in 2012, the USPSTF recommended against PSA-based screening due to risk for overdiagnosis and overtreatment. However, the updated 2018 guidelines recommend consideration of screening for certain at risk men and revised the recommendation rating from "D" to "C." This new guideline recommends providers to educate high-risk men on the benefits and harms of PSA-based PCa screening so that they can make an informed decision. The Affordable Care Act (ACA) includes provisions of service coverage for patient navigators who can help patients decide whether screening is appropriate, given potential risks and benefits, and training of health care providers in shared-decision regarding screening/treatment. These services can be utilized to support health care providers to better adhere to the new guideline. However, recommendations that are given a C rating or lower are not consistently reimbursed through many plans, including those offered through the ACA marketplace. The Society of Behavioral Medicine (SBM) supports the USPSTF guideline for the consideration of prostate cancer screening for high-risk men between the ages of 55 and 69. SBM encourages policymakers to include provisions for coverage of patient navigation services in the ACA to facilitate shared decision-making between providers and patients regarding screening.
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Affiliation(s)
- Karriem Watson
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Joanna Buscemi
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Marian Fitzgibbon
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Adam Murphy
- Department of Urology, Northwestern University, Evanston, IL, USA
| | - Michael Abern
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Peter Gann
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Josef Ben Levi
- College of Education, Northeastern Illinois University, Chicago, IL, USA
| | - James Stinson
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Robert A Winn
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
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Woods-Burnham L, Stiel L, Martinez SR, Sanchez-Hernandez ES, Ruckle HC, Almaguel FG, Stern MC, Roberts LR, Williams DR, Montgomery S, Casiano CA. Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men. CANCER HEALTH DISPARITIES 2020; 4:https://companyofscientists.com/index.php/chd/article/view/169/188. [PMID: 35252767 PMCID: PMC8896511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Recent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality that disproportionately affect African American (AA) men have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in AA men and other men of African ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling. This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates both AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR-together with specific genetic drivers-may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities. Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators should assess racial differences in therapy response and clinical outcomes in order to improve PCa health disparities that continue to exist for AA men.
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Affiliation(s)
- Leanne Woods-Burnham
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Laura Stiel
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
| | - Shannalee R. Martinez
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Evelyn S. Sanchez-Hernandez
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Herbert C. Ruckle
- Department of Surgical Urology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Frankis G. Almaguel
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Loma Linda University Cancer Center, Loma Linda, CA, USA
| | - Mariana C. Stern
- Departments of Preventive Medicine and Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Lisa R. Roberts
- Loma Linda University School of Nursing, Loma Linda, CA, USA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard University School of Public Health
| | - Susanne Montgomery
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
| | - Carlos A. Casiano
- Center for Health Disparities and Molecular Medicine and Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Henning GM, Vetter JM, Drake BF, Ippolito JE, Shetty AS, Andriole GL, Kim EH. Diagnostic Performance of Prostate Multiparametric Magnetic Resonance Imaging in African-American Men. Urology 2019; 134:181-185. [DOI: 10.1016/j.urology.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/15/2022]
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Grizzle WE, Kittles RA, Rais-Bahrami S, Shah E, Adams GW, DeGuenther MS, Kolettis PN, Nix JW, Bryant JE, Chinsky R, Kearns JE, Dehimer K, Terrin N, Chang H, Gaston SM. Self-Identified African Americans and prostate cancer risk: West African genetic ancestry is associated with prostate cancer diagnosis and with higher Gleason sum on biopsy. Cancer Med 2019; 8:6915-6922. [PMID: 31568648 PMCID: PMC6853835 DOI: 10.1002/cam4.2434] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 01/07/2023] Open
Abstract
Concerns about overtreatment of clinically indolent prostate cancer (PrCa) have led to recommendations that men who are diagnosed with low-risk PrCa be managed by active surveillance (AS) rather than immediate definitive treatment. However the risk of underestimating the aggressiveness of a patient's PrCa can be a significant source of anxiety and a barrier to patient acceptance of AS. The uncertainty is particularly keen for African American (AA) men who are about 1.7 times more likely to be diagnosed with PrCa than European American (EA) men and about 2.4 times more likely to die of this disease. The AA population, as many other populations in the Americas, is genetically heterogeneous with varying degrees of admixture from West Africans (WAs), Europeans, and Native Americans (NAs). Recommendations for PrCa screening and management rarely consider potential differences in risk within the AA population. We compared WA genetic ancestry in AA men undergoing standard prostate biopsy who were diagnosed with no cancer, low-grade PrCa (Gleason Sum 6), or higher grade PrCa (Gleason Sum 7-10). We found that WA genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer-negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7-10). Incorporating WA ancestry into the guidelines for making decisions about when to obtain a biopsy and whether to choose AS may allow AA men to personalize their approach to PrCa screening and management.
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Affiliation(s)
- William E Grizzle
- Department of Pathology and Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rick A Kittles
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | | | - Ebony Shah
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | | | | | - Peter N Kolettis
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James E Bryant
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Norma Terrin
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hong Chang
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sandra M Gaston
- Tufts Medical Center, Boston, MA, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
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Mitchell KA, Williams H. Emerging genomic biomarkers for improving kidney, prostate, and bladder cancer health disparities outcomes. Urol Oncol 2019; 40:126-132. [PMID: 31239186 DOI: 10.1016/j.urolonc.2019.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent advances in genomic and genetic technologies have facilitated better health outcomes for urologic cancer patients. Genomic and genetic heterogeneity may contribute to differences in tumor biology and urologic cancer burden across various populations. OBJECTIVE To examine how emerging genomic and genetic biomarkers, self-reported race, and ancestry-informative markers are associated with kidney, prostate, and bladder cancer outcomes. RESULTS Genomic and genetic alterations found in African American kidney cancer patients included distinct somatic mutations, somatic copy number alterations, chromosomal instability, germ-line risk alleles, and germ-line genetic variants. These changes correlated with improved risk prediction, prognosis, and survival; and a predicted decrease in response to targeted therapies. SNP risk alleles and ancestry-informative markers were associated with improved risk prediction in prostate cancer patients of both African and European descent. AKT activation suggest differential response to AKT-targeted therapies in African American, Asian American, and Tunisian bladder cancer patients. Both self-reported race and genetic ancestry predicted urologic cancer risk prediction. CONCLUSION Precision medicine approaches that integrate population-specific genomic and genetic information with other known urologic cancer-specific characteristics can improve outcomes and be leveraged to reduce cancer health disparities. Further investigations are necessary to identify novel genomic biomarkers with clinical utility.
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Affiliation(s)
| | - Heinric Williams
- Urology Department, Geisinger Clinic, Danville, PA; Weis Center for Research, Geisinger Clinic, Danville, PA.
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Mahran A, Mishra K, Bukavina L, Schumacher F, Quian A, Buzzy C, Nguyen CT, Gulani V, Ponsky LE. Observed racial disparity in the negative predictive value of multi-parametric MRI for the diagnosis for prostate cancer. Int Urol Nephrol 2019; 51:1343-1348. [DOI: 10.1007/s11255-019-02158-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/20/2019] [Indexed: 12/31/2022]
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