Update on prostate cancer in black men within the UK

Prostate Cancer Among Black Men in Canada

Importance

Prostate cancer is a prevalent disease among men worldwide, exhibiting substantial heterogeneity in presentation and outcomes influenced by various factors, including race and ethnicity. Disparities in incidence, stage at diagnosis, and survival rates have been observed between Black men and those of other races and ethnicities.

Objective

To compare prostate cancer outcomes between Black men and men with other race (Asian, Hispanic, Indigenous, Middle Eastern, White, Multiracial, and Other) in a universal health care system, with race and ethnicity self-reported.

Design, Setting, and Participants

This was a prospective, observational cohort study of men diagnosed with prostate cancer between June 1, 2014, and August 28, 2023, who self-identified race and ethnicity. Participants included men who had been prospectively enrolled in the Alberta Prostate Cancer Research Initiative from the 2 major urology referral centers in Alberta (University of Alberta and University of Calgary). All men with prostate cancer enrolled in the initiative were included.

Exposure

Race and ethnicity.

Main Outcomes and Measures

The primary outcome was the stage and grade of prostate cancer at diagnosis. Further outcomes included age and prostate-specific antigen level at diagnosis, initial treatment modality, time from diagnosis to initial treatment, and prostate cancer-specific, metastasis-free, and overall survivals.

Results

A total of 6534 men were included; 177 (2.7%) were Black, and 6357 (97.3%) had another race or ethnicity. Men who identified as Black were diagnosed with prostate cancer at an earlier age (mean [SD], 62.0 [8.2] compared with 64.6 [7.7] years; P < .001) and had a lower Charlson Comorbidity Index rating (14% compared with 7% ≤ 1; P < .001) compared with men of other races. Men who identified as Black had similar prostate-specific antigen levels at diagnosis, TNM category (74% vs 74% with T1-T2; P = .83) and Gleason Grade Group (34% compared with 35% Gleason Grade Group 1; P = .63). Black men had similar rates of prostate cancer-specific (hazard ratio [HR], 1.10; 95% CI, 0.41-2.97; P = .85), metastasis-free (HR, 0.88; 95% CI, 0.42-1.46; P = .44), and overall (HR, 0.55; 95% CI, 0.25-1.24; P = .15) survival.

Conclusions and Relevance

The findings of this cohort study suggest that Black men, despite being diagnosed at a younger age, experience comparable prostate cancer outcomes compared with men of other races.

Genetic ancestry and radical prostatectomy findings in Hispanic/Latino patients

Background

African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia.

Patients and methods

We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry Informative Markers. We examined the associations of the genetic ancestry components with the Gleason Grade Groups (GG) and the clinicopathological characteristics.

Results

No association was observed between the genetic ancestry with the biochemical recurrence or Gleason GG; however, in a two groups comparison, there were statistically significant differences between GG3 and GG4/GG5 for European ancestry, with a higher mean ancestry proportion in GG4/GG5. A lower risk of being diagnosed at an advanced age was observed for patients with high African ancestry than those with low African ancestry patients (OR: 0.96, CI: 0.92-0.99, p=0.03).

Conclusion

Our findings revealed an increased risk of presentation of PC at an earlier age in patients with higher African ancestry compared to patients with lower African ancestry in our Hispanic/Latino patients.

The impact of radical prostatectomy on the social well-being of prostate cancer survivors: A qualitative meta-synthesis

INTRODUCTION

The impact of radical prostatectomy on the social well-being of survivors remains poorly understood. This meta-synthesis therefore aimed to integrate the findings of qualitative research evaluating the impact of surgery on the patient relationships with partners, family and wider societal interactions.

METHODS

Medline, CINAHL, PsycINFO and Embase were searched for qualitative studies evaluating social well-being dimensions. A thematic meta-synthesis was conducted to inductively construct descriptive themes and overarching analytical themes.

RESULTS

Thirty-one articles were included, with seven descriptive themes under two analytical themes generated to describe the experiences of 469 participants. 'Pathway to Conversion' encompassed three themes on the evolving social behaviour of men with both partners and family to adapt to their new normality postoperatively. 'A Man on My Own' discussed four themes focussing on both intimate and wider social relations, describing the stigma, shame and embarrassment felt by patients due to changes in their perceived body image and physical function. This resulted in men feeling alone, unsupported and seeking isolation.

CONCLUSION

Radical prostatectomy's impact on survivors' social well-being extends beyond surgery and causes a shift in their relationship dynamics with partner and family, highlighting the importance of preoperative and postoperative clinician's counselling to both patient and partner.

Prostate cancer risk in men of differing genetic ancestry and approaches to disease screening and management in these groups

Prostate cancer is the second most common solid tumour in men worldwide and it is also the most common cancer affecting men of African descent. Prostate cancer incidence and mortality vary across regions and populations. Some of this is explained by a large heritable component of this disease. It has been established that men of African and African Caribbean ethnicity are predisposed to prostate cancer (PrCa) that can have an earlier onset and a more aggressive course, thereby leading to poorer outcomes for patients in this group. Literature searches were carried out using the PubMed, EMBASE and Cochrane Library databases to identify studies associated with PrCa risk and its association with ancestry, screening and management of PrCa. In order to be included, studies were required to be published in English in full-text form. An attractive approach is to identify high-risk groups and develop a targeted screening programme for them as the benefits of population-wide screening in PrCa using prostate-specific antigen (PSA) testing in general population screening have shown evidence of benefit; however, the harms are considered to weigh heavier because screening using PSA testing can lead to over-diagnosis and over-treatment. The aim of targeted screening of higher-risk groups identified by genetic risk stratification is to reduce over-diagnosis and treat those who are most likely to benefit.

How can we recruit more men of African or African-Caribbean ancestry into our research? Co-creating a video to raise awareness of prostate cancer risk and the PROFILE study

BACKGROUND

Men of African ancestry are at increased risk of developing prostate cancer (PrCa) compared to men from other backgrounds. The PROFILE study aims to understand whether genetic information can better target who needs PrCa screening. PROFILE has so far had difficulty reaching men of African or African -Caribbean ancestry to take part. In this involvement project we worked in partnership with a group of such men to co-create a video to raise awareness of PrCa risk amongst this community and promote participation in the study.

METHODS

We recruited seven men of African or African-Caribbean ancestry who completed an initial survey on the Cancer Patients' Voice platform. We then held an online discussion panel and maintained contact to encourage dialogue and planning of the video. Utilising a participatory approach, the ideas for the video were decided in collaboration with the panel who held expert knowledge of various communities and understood the messages that would best resonate and engage with other men of the same origins. Once the video had been edited and finalised, two members of the group expressed interest in writing up the project and are listed as co-authors.

RESULTS

The video in its entirety was driven by the panel's ideas. The choice of a barber shop setting; leading with a positive case study and highlighting the importance of men's family members rather than a focus on scientific language, statistics or researchers were all features that were discussed and agreed upon by the panel. The men shared the video within their networks. It was placed on websites and promoted as part of a social media campaign during Black History Month.

CONCLUSIONS

Groups with the greater healthcare needs and the most to gain from advances in care and treatment can often be the most excluded from research participation. This is pertinent in PrCa research where men of African or African-Caribbean ancestry are at greater risk. The project gave equal power and decision making to the men and provides an example of successful inclusive involvement. The result was a unique approach to making a study video.

A Systems Approach to Interrogate Gene Expression Patterns in African American Men Presenting with Clinically Localized Prostate Cancer

Simple Summary

Men of African origin have a 2–3 times greater chance of developing prostate cancer than those of European origin, and of patients that are diagnosed with the disease, men of African descent are 2 times more likely to die compared to white men. Men of African origin are still greatly underrepresented in genetic studies and clinical trials. This, unfortunately, means that new discoveries in cancer treatment are missing key information on the group with a greater chance of mortality. The objective of this study was to increase our knowledge of prostate cancer in men undergoing a prostate biopsy. We carried out RNA sequencing of biopsy specimens and examined racial differences in prostate gene expression. A gene expression signature was uncovered which separated the men based on their race. Furthermore, within men of African descent this signature separated men with the most severe clinical characteristics.

Abstract

An emerging theory about racial differences in cancer risk and outcomes is that psychological and social stressors influence cellular stress responses; however, limited empirical data are available on racial differences in cellular stress responses among men who are at risk for adverse prostate cancer outcomes. In this study, we undertook a systems approach to examine molecular profiles and cellular stress responses in an important segment of African American (AA) and European American (EA) men: men undergoing prostate biopsy. We assessed the prostate transcriptome with a single biopsy core via high throughput RNA sequencing (RNA-Seq). Transcriptomic analyses uncovered impacted biological pathways including PI3K-Akt signaling pathway, Neuroactive ligand-receptor interaction pathway, and ECM-receptor interaction. Additionally, 187 genes mapping to the Gene Ontology (GO) terms RNA binding, structural constituent of ribosome, SRP-dependent co-translational protein targeting to membrane and the biological pathways, translation, L13a-mediated translational silencing of Ceruloplasmin expression were differentially expressed (DE) between EA and AA. This signature allowed separation of AA and EA patients, and AA patients with the most severe clinical characteristics. AA patients with elevated expression levels of this genomic signature presented with higher Gleason scores, a greater number of positive core biopsies, elevated dehydroepiandrosterone sulfate levels and serum vitamin D deficiency. Protein-protein interaction (PPI) network analysis revealed a high degree of connectivity between these 187 proteins.

Alteration of Metabolic Conditions Impacts the Regulation of IGF-II/H19 Imprinting Status in Prostate Cancer

Prostate cancer is the second major cause of male cancer deaths. Obesity, type 2 diabetes, and cancer risk are linked. Insulin-like growth factor II (IGF-II) is involved in numerous cellular events, including proliferation and survival. The IGF-II gene shares its locus with the lncRNA, H19. IGF-II/H19 was the first gene to be identified as being "imprinted"-where the paternal copy is not transcribed-a silencing phenomenon lost in many cancer types. We disrupted imprinting behaviour in vitro by altering metabolic conditions and quantified it using RFLP, qPCR and pyrosequencing; changes to peptide were measured using RIA. Prostate tissue samples were analysed using ddPCR, pyrosequencing and IHC. We compared with in silico data, provided by TGCA on the cBIO Portal. We observed disruption of imprinting behaviour, in vitro, with a significant increase in IGF-II and a reciprocal decrease in H19 mRNA; the increased mRNA was not translated into peptides. In vivo, most specimens retained imprinting status apart from a small subset which showed reduced imprinting. A positive correlation was seen between IGF-II and H19 mRNA expression, which concurred with findings of larger Cancer Genome Atlas (TGCA) cohorts. This positive correlation did not affect IGF-II peptide. Our findings show that type 2 diabetes and/or obesity, can directly affect regulation growth factors involved in carcinogenesis, indirectly suggesting a modification of lifestyle habits may reduce cancer risk.

Biparametric MRI prior to Radical Radiation Therapy for Prostate Cancer in a Caribbean Population: Implications for Risk Group Stratification and Treatment

PURPOSE

To assess risk-group migration and subsequent management change following biparametric MRI using a risk-stratified approach in a group of Caribbean men with prostate adenocarcinoma being offered external beam radiation therapy (EBRT).

MATERIALS AND METHODS

This retrospective study assessed the biparametric MRI findings in men who opted for EBRT from January 2018 to June 2019 (n = 79; mean age, 67.9 years ± 6.2 [standard deviation]). Serum prostate-specific antigen level, digital rectal examination findings, histologic grade group (GG) from transrectal US-guided biopsy, prior androgen deprivation therapy (ADT), and any prior CT results were used to stratify patients into low-, intermediate-, and high-risk groups, according to the National Comprehensive Cancer Network risk categories. Risk-group stratification prior to MRI separated patients into low- (seven of 79 [8.9%]), intermediate- (36 of 79 [45.6%]) and high-risk (36 of 79 [45.6%]) groups. Following MRI, any risk group (low, intermediate, high, nodal involvement, and metastatic disease) or oncologic management changes were recorded. Multivariable binary logistic regression analyses were used to assess predictor of upgrade status, with adjustment for demographic covariates jointly.

RESULTS

Following MRI, 30 of 79 (38.0%) patients had risk-group upshifts compared with their original assessment. Patients were recategorized into low risk (one of 79, 1.3%), intermediate risk (19 of 79, 24.1%), high risk (51 of 79, 64.6%), nodal involvement (one of 79, 1.3%), and metastatic disease (seven of 79, 8.9%). From the original groupings, there were six of seven (85.7%) from the low group, 18 of 36 (50.0%) from the intermediate group, and six of 36 (16.7%) from the high group that had risk group upward shifts. There was no association with GG: GG2 versus GG1, P = .53; GG3 versus GG1, P = .98; or prior ADT (P = .37) and the adjusted odds of risk-group upshifts. MRI findings resulted in treatment plan modification for 39 of 79 (49.4%) men overall.

CONCLUSION

Prostate MRI should be considered for patients in high-risk populations prior to EBRT because upstaging from MR image assessment may have implications for modification of treatment.Keywords: MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020See the commentary by Davenport and Shankar in this issue.

Awareness and Attitudes of Nigerian Men Living in Abuja on Prostate Cancer and Screening

Prostate cancer (PCa) is the most commonly diagnosed cancer among Nigerian men. The prevalence of PCa varies within Nigeria, with the highest prevalence of 1046 per 100,000 in men over the age of 40 reported in Lagos. Unfortunately, 40% of these men are diagnosed with locally advanced disease and 35% with metastatic disease. Given the ability to screen for PCa among high-risk individuals, late stage diagnosis of PCa could be potentially reduced through education of men so that they seek screening. Along these lines, it is important to assess a population's knowledge and awareness on PCa and screening. Our study addresses this issue by evaluating awareness and attitudes of Nigerian men in Abuja on PCa and screening. Our results revealed gaps in awareness and perception of susceptibility to PCa and low levels of PCa screening. Factors such as age, education level, and income affected PCa awareness. In conclusion, our study points to the need to educate younger men of lower education and socioeconomic status in Nigeria with the aim to increase screening and earlier detection of PCa.

"…It might not have occurred to my husband that this woman, his wife who is taking care of him has some emotional needs as well…": the unheard voices of partners of Black African and Black Caribbean men with prostate cancer

PURPOSE

Evidence suggests that partners of men with prostate cancer (CaP) experience greater psychosocial distress compared with men themselves. However, the experiences of partners of high-risk (1 in 4) Black African (BA) and Black Caribbean (BC) men with CaP remain poorly understood as existing research has predominantly focused on Caucasian populations. This study aimed to address this gap by exploring partners' experience and support needs as influenced both by the specific impacts of CaP, treatment side effects and socio-cultural context.

METHODS

Using a constructivist grounded theory approach, eight face-to-face, two Skype and one telephone interviews were conducted with eligible partners (n = 11). The interviews were analysed using constant comparison following key stages of open, focused and theoretical coding.

RESULTS

Three broad categories emerged which described participants' experiences: 'partner in the passenger seat', 'care-giving on an isolating journey', and 'coping as a partner'. Findings showed that BA and BC cultural marital context influenced how partners experienced and traversed the CaP journey. Peripheral involvement in decision-making, communication restrictions, limited access to support and lack of recognition for their experiences and needs further contributed to partners' psychological and emotional distress.

CONCLUSIONS

Cultural beliefs, behaviours and values should be taken into account when developing psychosocial support for partners and their men with CaP. Specifically providing information focused on partners and including them in the CaP care pathway could help ensure that partners' needs are recognised and improve marital communications. This could potentially help partners and their men to identify acceptable ways of supporting each other throughout the CaP experience.

Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010

BACKGROUND

In the UK, a man's lifetime risk of being diagnosed with prostate cancer is 1 in 8. We calculated both the lifetime risk of being diagnosed with and dying from prostate cancer by major ethnic group.

METHODS

Public Health England provided prostate cancer incidence and mortality data for England (2008-2010) by major ethnic group. Ethnicity and mortality data were incomplete, requiring various assumptions and adjustments before lifetime risk was calculated using DevCan (percent, range).

RESULTS

The lifetime risk of being diagnosed with prostate cancer is approximately 1 in 8 (13.3 %, 13.2-15.0 %) for White men, 1 in 4 (29.3 %, 23.5-37.2 %) for Black men, and 1 in 13 (7.9 %, 6.3-10.5 %) for Asian men, whereas that of dying from prostate cancer is approximately 1 in 24 (4.2 %, 4.2-4.7 %) for White men, 1 in 12 (8.7 %, 7.6-10.6 %) for Black men, and 1 in 44 (2.3 %, 1.9-3.0 %) for Asian men.

CONCLUSIONS

In England, Black men are at twice the risk of being diagnosed with, and dying from, prostate cancer compared to White men. This is an important message to communicate to Black men. White, Black, and Asian men with a prostate cancer diagnosis are all as likely to die from the disease, independent of their ethnicity. Nonetheless, proportionally more Black men are dying from prostate cancer in England.