Global Patterns of Prostate Cancer Incidence, Aggressiveness, and Mortality in Men of African Descent

Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 217 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
Prostate cancer 02/2013; 2013(2):560857. DOI: 10.1155/2013/560857
Source: PubMed


Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

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    • "It is also often aggressive and discovered at later stages. Rebbeck et al [1] observed that lower rates of PCa in Africa may in part reflect a lower probability of PCa detection than in countries like the US where prostate-specific antigen (PSA) and digital rectal examination (DRE) screening have been more widely used. The authors also commented that African-specific risk profiles may require different screening and treatment strategies in Africa than those in standard practice in North America or Europe. "
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    ABSTRACT: Prostate cancer (PCa) has become the most prevalent cancer among males in Nigeria, and similar to other black populations, Nigerian men present with more advanced disease at an earlier age than in several other ethnic groups. In this unscreened, high-risk group, the reference range for early detection and diagnosis as well as risk factors need to be determined through large-scale screening. Over 4 years, 1124 previously unscreened men between 40 and 85 years of age were screened at free community health programmes for PCa, using the common parameters of prostate-specific antigen (PSA) plus digital rectal examination (DRE). We thereby assessed the practicality and importance of screening. Consent was obtained, demographic data obtained, PSA measured using qualitative laboratory kits, and DRE performed by surgeons. We found that the number of men attending and consenting to screening increases from year to year. Of 40–85-year-old men, 85.4% consented, of whom 33.3% (a third) and 60% were 51–60 years old and 51–65 years, respectively. While 11.5% of men had PSA >4 ng/ml, 31.45% showed abnormal DRE. Of the men who took the PSA test, 79.2% also consented to the DRE, of whom 5.8% had combined abnormal DRE and PSA >4 ng/ml. Our findings suggest that Nigerian men are a willing group for screening by both the PSA and DRE with the positive response to calls for health screening and interest in prostate health. The finding of PSA >4 ng/ml in 11.15% of this population reveals the need for greater awareness and measures to increase early detection. However, the value and validity of established PSA reference ranges and cutoff of ‘normal’ still need to be established. Screening is very important to better define the PCa prevalence and characteristics in our population; otherwise political and economic circumstances will ensure that men still present late with aggressive PCa.
    ecancermedicalscience 08/2014; 8:457. DOI:10.3332/ecancer.2014.457 · 1.20 Impact Factor
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    • "This study generated interest in this field and resulted in a collaboration known as the Prostate Cancer in Ethnic Subgroups (PROCESS) study group [9, 11, 21]. Between 1997 and 2001, the data were analysed from a larger retrospective cohort in London and Bristol, cities with a relatively high populous of black communities. "
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    ABSTRACT: There is a wealth of evidence which can be traced back to the African transatlantic slave trade indicating that black men have a higher risk of prostate cancer compared to other ethnic groups. Migration to Westernised countries may have had little effect on the incidence of prostate cancer in this ethnic group; however, current evidence indicates that there are several complex factors that may contribute to this risk. Studies in the UK quote that black men are at 2–3 times the risk of prostate cancer in comparison to their Caucasian counterparts, with a 30% higher mortality rate. Caution should be taken prior to the interpretation of these results due to a paucity of research in this area, limited accurate ethnicity data, and lack of age-specific standardisation for comparison. Cultural attitudes towards prostate cancer and health care in general may have a significant impact on these figures, combined with other clinico-pathological associations. This update summarises new contributory research on this subject, highlighting the need to increase awareness and understanding of prostate cancer amongst high-risk communities and to support further robust research in this area by nominating a lead in cancer and ethnicity studies within the National Health Service.
    ecancermedicalscience 08/2014; 8:455. DOI:10.3332/ecancer.2014.455 · 1.20 Impact Factor
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    • "In men of African descent, worldwide, the mortality rates are much higher compared to those of men of other ethnicities [33]. Data from the Surveillance, Epidemiology, and End Results (SEER) Programme clearly indicate a higher incidence in African Americans, both in terms of morbidity and mortality at an earlier age, and with more advanced disease at initial onset [34]. The high mortality rates in the Caribbean led the global trends data [1]. "
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    ABSTRACT: Prostate cancer in black men of African descent has a different tumour biology compared to those of other races. Its clinical manifestations depict a more aggressive disease with higher morbidity and mortality. This study proposes, through a literature search, identifying applied laboratory and clinical research in prostate cancer directed to improve outcomes and decrease global disparities of prostate cancer in black men of African descent. This review identified five categories pertinent for research: prostate-specific antigen (PSA) testing for early detection and screening, the potential of epigenetics, cultural determinants and health-seeking behaviours, other biomarkers for prostate cancers, and the economics of treating advanced prostate cancer. The analysis revealed that in developed countries, men of African descent are underrepresented in the sampling pools in both laboratory and clinical research, and thus the applicability and relevance of these results to men of African descent are circumspect. However, developing countries with high populations of black males have limited laboratory and clinical research publications. This is due to limited funding to support research programmes and basic clinical services for early detection and treatment. The study concludes that for the involvement of developing countries in bench research, they should do it in collaboration, like fostering partnerships with credible academic-based institutions and organisations. This requires a realm of transparency, respect, protection of the rights and dignity of the patients, and an equity in participation and sharing of the benefits to be accrued. The current transatlantic and Caribbean collaborations in research, education, and health service delivery in prostate cancer care for men of African descent exemplify the successes of such partnerships.
    ecancermedicalscience 08/2014; 8. DOI:10.3332/ecancer.2014.458 · 1.20 Impact Factor
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