Racial differences in a prostate cancer screening study
ABSTRACT We attempted to determine whether black men have a higher prostate cancer prevalence and more advanced disease.
We screened 17,157 white and 804 black men 50 years old or older by serum prostate specific antigen measurement and digital rectal examination. We recommended biopsy when either test was suspicious.
Black men had a higher prevalence of elevated prostate specific antigen (13.1 versus 8.9%) and cancer (5.1 versus 3.2%) than white men, and a higher prevalence of clinically but not pathologically advanced cancer. Fewer black men in lower income zip codes complied with recommendations for biopsy.
In our screening study black men had a higher prevalence of detectable cancer. However, unlike in clinical studies there was no striking racial difference in advanced cancer stage at diagnosis.
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ABSTRACT: Prostate cancer (PCa) is the most frequently diagnosed non-cutaneous cancer that has become the sixth leading cause of mortality in both the developed and developing countries. Accumulating evidence showed a number of genes with aberrant DNA methylation in the pathogenesis of PCa. Here, we conducted a systematic meta-analysis to evaluate the contribution of aberrantly methylated genes to the risk of PCa. Relevant methylation studies were retrieved from PubMed and Wanfang literature databases. In the meta-analysis, Mantel-Haenszel odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each methylation event under appropriate models. A total of 594 publications were initially retrieved from PubMed and Wanfang literature database. After a three-step filtration, we harvested 39 case-control articles investigating the role of gene methylation in the prediction of PCa risk. Among the 31 genes involved, 24 genes were shown to be significantly hypermethylated in the PCa patients. Our meta-analyses identified strong associations of four aberrantly methylated genes (GSTP1, RASSF1, p16, and RARB) with PCa. Further research is needed to strengthen our findings in the future.Tumor Biology 07/2014; 35(10). DOI:10.1007/s13277-014-2300-7 · 2.84 Impact Factor
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ABSTRACT: Reasons for the high rates of prostate cancer in African Americans are unknown; both genetic and lifestyle factors have been implicated. A better understanding of prostate cancer rates in West Africans would help clarify why African Americans have such high rates, since African Americans share genetic ancestry with West Africans yet have very different lifestyles and screening practices. To estimate prostate cancer burden in West Africans, we conducted a population-based screening study with biopsy confirmation in Ghana. We randomly selected 1,037 healthy men aged 50-74 from Accra, Ghana for prostate cancer screening with prostate specific antigen (PSA) testing and digital rectal examination (DRE). Men who had a positive screen (DRE+ or PSA>2.5 ng/ml) underwent transrectal ultrasound (TRUS)-guided biopsies. Of the 1,037 men, 154 (14.9%) had a positive DRE and 272 (26.2%) had a PSA>2.5 ng/ml (166 had a PSA>4.0 ng/ml). In total, 352 (33.9%) men had a positive screen by PSA or DRE, and 307 (87%) had a biopsy. Of these, 73 were confirmed to have prostate cancer, yielding a 7.0% screen-detected prevalence of prostate cancer (65 cases, 5.8% with a PSA>4.0 ng/ml). In this relatively unscreened population in Africa, the screen-detected prostate cancer prevalence is high, suggesting a possible role of genetics in both prostate cancer etiology and the disparity in prostate cancer risk between African Americans and Caucasian Americans. Further studies are needed to confirm the high prostate cancer burden in Africans and the role of genetics in prostate cancer etiology.The Journal of urology 04/2014; 192(3). DOI:10.1016/j.juro.2014.04.017 · 3.75 Impact Factor
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ABSTRACT: In the U.S., the number of prostate biopsies increases annually. This is partly due to elevated prostate specific antigen (PSA) values identified during PC screening. This study's goal was improving prostate cancer (PC) detection through developing a clinical decision rule (CDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after an elevated PSA, providing the patient and clinician information to consider prior to biopsy. This cross-sectional study evaluated men from the Tampa, Florida, James A. Haley (JH) VA (N=1,378), from January 1, 1998, through April 15, 2005. The study hypothesized that specific lab biomarkers among JH VA PC cases would differ significantly from JH VA patients without PC. The following biomarkers were related to PC: hemoglobin (HGB) (OR=1.42 95%CI 1.27, 1.59); red blood cell count (RBC) (OR=2.52 95%CI 1.67, 3.78); PSA (OR=1.04 95%CI 1.03, 1.05); and, creatinine (OR=1.55 95%CI 1.12, 2.15). This study attempted to determine whether including specific biomarkers (that are related to systemic diseases associated with advancing PC) could improve PC prediction (versus PSA alone). Comparing all PC stages versus non-cancerous conditions, the Receiver Operator Characteristic (ROC) curve area under the curve (AUC) expanded (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); CDR model 0.68 (95%CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; CDR model 61.8%. Comparing PC (stages B, C, D) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); CDR model 0.68 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); CDR model 55.3%. These results suggest evaluating certain biomarkers might improve PC prediction prior to biopsy. Moreover, the biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA data-sets involving multiple practices.