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Batura D, Patel A, Gandhi A, Pradhan A, Bachoo S, Tetea AA, Bassett P, Hellawell G. Ethnic differences in prostate cancer presentation: a time for testing advocacy. World J Urol 2023; 41:3543-3549. [PMID: 37821779 DOI: 10.1007/s00345-023-04644-0] [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: 03/08/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE It is recognised that there are ethnic variations in prostate cancer (PCa) epidemiology, affecting outcomes. South Asians (SA) are less likely to be diagnosed with PCa than others, although recent evidence shows PCa is rising amongst SA. This study examines the differences between ethnicities in PCa presentation, progression risk and prostate-specific antigen (PSA) testing use. METHODS This retrospective study is on biopsy-diagnosed PCa patients from a multi-ethnic area in London. We grouped ethnicities as SA, White, Black and others, compared presenting symptoms, PSA, Gleason score (GS), and clinical stage, and estimated the D'Amico risk across ethnicities. We also evaluated if the presentation was due to symptoms or an elevated PSA. RESULTS We studied 1176 patients with biopsy-proven PCa. Black patients were diagnosed about 3 years before others (65 ± 8.8 years, p = < 0.001). There was no significant difference between ethnicities in presenting PSAs. At presentation, 65-71% were in the high-risk D'Amico category across all ethnicities. SA were least likely to have PSA test-detected cancers (38%, p = 0.001) and had the highest proportion with advanced GS (30.6%). There was no significant difference in the risk of disease progression between groups. CONCLUSION Black men were diagnosed youngest. SA had the highest proportion with advanced GS. Most ethnicities had a high risk of progression. SA had the least PSA test-detected cases. The significance of the study lies in understanding ethnic variations in PCa, which could direct targeted prevention and management. We recommend further ethnicity studies and interventions encouraging SA men to embrace PSA testing.
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Affiliation(s)
- Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
| | - Anish Patel
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Akash Gandhi
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Ameena Pradhan
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Samsara Bachoo
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Alina Alexandra Tetea
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Paul Bassett
- Statsconsultancy Ltd, 40 Longwood Lane, Amersham, HP7 9EN, UK
| | - Giles Hellawell
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
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Lillard JW, Moses KA, Mahal BA, George DJ. Racial disparities in Black men with prostate cancer: A literature review. Cancer 2022; 128:3787-3795. [PMID: 36066378 PMCID: PMC9826514 DOI: 10.1002/cncr.34433] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 01/11/2023]
Abstract
Black men are disproportionately affected by prostate cancer (PCa), with earlier presentation, more aggressive disease, and higher mortality rates versus White men. Furthermore, Black men have less access to PCa treatment and experience longer delays between diagnosis and treatment. In this review, the authors discuss the factors contributing to racial disparities and present solutions to improve access to care and increase clinical trial participation among Black men with PCa. Racial disparities observed among Black men with PCa are multifaceted, evolving from institutional racism. Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on PCa and treatment options, fear of PCa diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time, and cancer debt, play an important role in racial disparities observed in PCa treatment and outcomes. Racial diversity is often lacking in genomic and precision medicine studies. Black men are largely underrepresented in key phase 3 PCa trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams, and bias of health care providers to recommend clinical research. The authors propose solutions to address these factors that include educating clinicians and institutions on the barriers Black men experience, increasing the diversity of health care providers and clinical research teams, and empowering Black men to be involved in their treatment, which are keys to creating equity for Black men with PCa. LAY SUMMARY: Prostate cancer negatively affects Black men more than men of other races. The history of segregation and mistreatment in the health care system may contribute to mistrust among Black men. Outcomes are worse for Black men because they are less likely to be screened or to receive treatment for prostate cancer. Black men also are unlikely to participate in clinical research, making it difficult for investigators to understand how Black men are affected by prostate cancer. Suggestions for addressing these differences include teaching physicians and nurses about the issues Black men experience getting treatment and improving how Black men get information on prostate cancer.
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Affiliation(s)
- James W. Lillard
- Department of MicrobiologyBiochemistry, and Immunology, Morehouse School of MedicineAtlantaGeorgiaUSA
| | - Kelvin A. Moses
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brandon A. Mahal
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Daniel J. George
- Duke Cancer InstituteUniversity School of MedicineDurhamNorth CarolinaUSA
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Nyame YA, Cooperberg MR, Cumberbatch MG, Eggener SE, Etzioni R, Gomez SL, Haiman C, Huang F, Lee CT, Litwin MS, Lyratzopoulos G, Mohler JL, Murphy AB, Pettaway C, Powell IJ, Sasieni P, Schaeffer EM, Shariat SF, Gore JL. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol 2022; 82:341-351. [PMID: 35367082 DOI: 10.1016/j.eururo.2022.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes. OBJECTIVE To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions. EVIDENCE ACQUISITION A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes. EVIDENCE SYNTHESIS Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men. CONCLUSIONS Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes. PATIENT SUMMARY Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
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Affiliation(s)
- Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA
| | - Franklin Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Isaac J Powell
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Peter Sasieni
- Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Hinata N, Fujisawa M. Racial Differences in Prostate Cancer Characteristics and Cancer-Specific Mortality: An Overview. World J Mens Health 2022; 40:217-227. [PMID: 35021294 PMCID: PMC8987139 DOI: 10.5534/wjmh.210070] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
Racial differences of prostate cancer incidence and mortality among Asian, Black, and Caucasian men have been known, however, comprehensive update of this topic is not yet reported. In the present review, an overview of the racial differences in prostate cancer characteristics and cancer-specific mortality is collected and reviewed. Regarding racial differences of incidence and mortality, surprising differences in the incidence of prostate cancer are seen among different populations around the world, with some countries having rates that are 60 to 100 times higher than others. African-American men have a higher incidence of prostate cancer, higher prostate cancer mortality, and are diagnosed with prostate cancer at a younger age than Caucasian American men. Furthermore, race is gaining attention as an important factor to consider for planning active surveillance for localized prostate cancer, especially among African-Americans. In addition, the causes of these differences are being elucidated by genomic profiling. Determinants of racial disparities are multifactorial, including socioeconomic and biologic factors. Although race-specific differences in prostate cancer survival estimates appear to be narrowing over time, there is an ongoing need to continue to understand and mitigate racial factors associated with disparities in health care outcomes.
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Affiliation(s)
- Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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McNevin CS, Cadoo K, Baird AM, Murchan P, Sheils O, McDermott R, Finn S. Pathogenic BRCA Variants as Biomarkers for Risk in Prostate Cancer. Cancers (Basel) 2021; 13:cancers13225697. [PMID: 34830851 PMCID: PMC8616097 DOI: 10.3390/cancers13225697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Historically, the treatment of prostate cancer was a blanket approach for all. Prostate cancer has not benefitted from targeted treatments based on specific tumour characteristics (ie. Particular genetic or molecular patterns) the way other cancers have. This is important as studies have shown that prostate cancer patients with certain errors in their genes, such as BRCA2 or BRCA1, are more likely to have worse disease and poorer outcome. These patients can be treated successfully with a group of drugs called ‘PARP inhibitors’. This paper examines the prognostic, clinical and therapeutic role of BRCA2/BRCA1 mutations across the evolution of PCa. The impact of the inclusion of BRCA genes on genetic screening will also be outlined. Abstract Studies have demonstrated that men with Prostate Cancer (PCa) harboring BRCA2/BRCA1 genetic aberrations, are more likely to have worse disease and a poorer prognosis. A mutation in BRCA2 is known to confer the highest risk of PCa for men (8.6 fold in men ≤65 years) making BRCA genes a conceivable genomic biomarker for risk in PCa. These genes have attracted a lot of research attention however their role in the clinical assessment and treatment of PCa remains complex. Multiple studies have been published examining the relationship between prostate cancer and BRCA mutations. Here BRCA mutations are explored specifically as a biomarker for risk in PCa. It is in this context, we examined the prognostic, clinical and therapeutic role of BRCA2/BRCA1 mutations across the evolution of PCa. The impact of the inclusion of BRCA genes on genetic screening will also be outlined.
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Affiliation(s)
- Ciara S. McNevin
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, D08 W9RT Dublin, Ireland; (C.S.M.); (P.M.)
- Department of Medical Oncology, St. James Hospital, D08 NHY1 Dublin, Ireland;
| | - Karen Cadoo
- Department of Medical Oncology, St. James Hospital, D08 NHY1 Dublin, Ireland;
- School of Medicine, Trinity Translational Medicine Institute, St. James Hospital, D08 W9RT Dublin, Ireland; (A.-M.B.); (O.S.)
| | - Anne-Marie Baird
- School of Medicine, Trinity Translational Medicine Institute, St. James Hospital, D08 W9RT Dublin, Ireland; (A.-M.B.); (O.S.)
| | - Pierre Murchan
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, D08 W9RT Dublin, Ireland; (C.S.M.); (P.M.)
- Science Foundation Ireland Centre for Research Training in Genomics Data Science, School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, H91 TK33 Galway, Ireland
| | - Orla Sheils
- School of Medicine, Trinity Translational Medicine Institute, St. James Hospital, D08 W9RT Dublin, Ireland; (A.-M.B.); (O.S.)
| | - Ray McDermott
- Department of Medical Oncology, Tallaght University Hospital, D24 NR0A Dublin, Ireland;
- Department of Medical Oncology, St. Vincent’s University Hospital, D04 YN26 Dublin, Ireland
| | - Stephen Finn
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, D08 W9RT Dublin, Ireland; (C.S.M.); (P.M.)
- Department of Medical Oncology, St. James Hospital, D08 NHY1 Dublin, Ireland;
- Correspondence:
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Erfani P, Figueroa JF, Lam MB. Reforms to the Radiation Oncology Model: Prioritizing Health Equity. Int J Radiat Oncol Biol Phys 2021; 110:328-330. [PMID: 33989572 DOI: 10.1016/j.ijrobp.2021.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Jose F Figueroa
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Miranda B Lam
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts.
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