African Americans and Prostate Cancer

[odds ratio (OR), 1.68; 95% confidence interval (CI), 1.05-2.68] compared with individuals homozygous for the low-activity allele.
The association between SULT1A1 genotype and prostate cancer risk in African-Americans did not reach significance (OR, 1.60; 95% CI, 0.46-5.62). When SULT1A1 activity was considered, there was a strong association between increased SULT1A1 activity and prostate cancer risk in Caucasians (OR, 3.04; 95% CI, 1.8-5.1 and OR, 4.96; 95% CI, 3.0-8.3, for the second and third tertiles of SULT1A1 activity, respectively) compared with individuals in the low enzyme activity tertile.
A similar association was also found in African-American patients, with ORs of 6.7 and 9.6 for the second and third tertiles of SULT1A1 activity (95% CI, 2.1-21.3 and 2.9-31.3, respectively). When consumption of well-done meat was considered, there was increased risk of prostate cancer (OR, 1.42; 95% CI, 1.01-1.99 and OR, 1.68; 95% CI, 1.20-2.36 for the second and third tertiles, respectively).
When SULT1A1 activity was stratified by tertiles of meat consumption, there was greater risk of prostate cancer in the highest tertile of meat consumption. These results indicate that variations in SULT1A1 activity contributes to prostate cancer risk and the magnitude of the association may differ by ethnicity and be modified by meat consumption.

Urol Oncol. 2004 Jan-Feb;22(1):20-4.

Postprostatectomy cancer-free survival of African Americans is similar to non-African Americans after adjustment for baseline cancer severity.

Underwood W 3rd, Wei J, Rubin MA, Montie JE, Resh J, Sanda MG.

Department of Urology, University of Michigan, Ann Arbor, MI, USA.

African American men with localized prostate cancer are less likely than White men to receive a radical prostatectomy. This disparity may exist because African American men have prostate cancers that are more biologically aggressive. We investigated if similar stage cancers of African American men and White men show differences in cancer control after radical prostatectomy. Men with localized prostate cancer who underwent radical prostatectomy during a 6-yr period were stratified by race, and time to prostate-specific antigen recurrence was measured. We used Chi-square and t-tests to compare baseline clinical and pathological factors based on race. Cox proportional hazards model was used to determine effects of race on cancer control while controlling for baseline measures of cancer severity. There were 1,228 cases evaluated. At baseline, African American men were treated at a significantly younger age than White men (P = 0.0027) but showed no significant difference in prostate-specific antigen PSA, Gleason score, pathology stage, maximum tumor dimension, and surgical margin status. Multivariable Cox proportional hazards analysis controlling for cancer severity at prostatectomy revealed that cancer-free survival was not worse among African Americans compared to other subjects (P = 0.16). The responsiveness of prostate cancers among African American men to radical prostatectomy was similar to White men of similar stage and grade. Early detection in African American men may facilitate diagnosis of cancer amenable to prostatectomy. Studies are needed to evaluate the possible interaction of prostate cancer stage and grade shift in African American men and the disease free survival in this population.

Carcinogenesis. 2004 Jan 30

COX-2 gene promoter haplotypes and prostate cancer risk.

Panguluri RC, Long LO, Chen W, Wang S, Coulibaly A, Ukoli F, Jackson A, Weinrich S, Ahaghotu C, Isaacs W, Kittles RA.

National Human Genome Center at Howard University, Washington, DC 20060; National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR.

Cyclooxygenase-2 (COX-2) is a key rate-limiting enzyme that converts arachidonic acid into proinflamatory prostaglandins. COX-2 expression is strongly correlated with increased tumor microvasculature density and plays an important role in inhibiting apoptosis, stimulating angiogenesis and promoting tumor cell metastasis and invasion. However, little is known about the role sequence variation of the COX-2 gene contributes to prostate cancer. Thus, we searched for polymorphisms in the promoter region of the COX-2 gene using denaturing high performance liquid chromatography. Four single nucleotide polymorphisms (SNPs), -1285A/G, -1265G/A, -899G/C and -297C/G, were detected and confirmed by direct sequencing.
Three of the SNPs in the promoter region of COX-2 gene create at least three putative transcription factor binding sites and eliminate C/EBPalpha and NF-kb binding sites. A case-control study of the four SNPs in African American (N=288), Bini Nigerian (N=264), and European American (N=184) prostate cancer cases and age matched controls revealed that SNP -297G was associated with decreased risk for prostate cancer (Odds Ratio [OR]=0.49; CI=0.2-0.9; P=0.01). The effect on risk was observed in both African Americans (OR=0.51; CI=0.2-0.9; P=0.01) and European Americans (OR=0.33; CI=0.1-0.9; P=0.02).
In addition, SNPs -1265A and -899C were associated with increased prostate cancer risk in African Americans (OR=2.72; CI=1.3-5.8; P=0.007 and OR=3.67; CI=1.4-9.9; P=0.007, respectively). Haplotype analyses revealed modest effects on susceptibility to prostate cancer across populations. Haplotype GGCC conferred increased risk in the African American and Nigerian populations.
Conversely, haplotype AGGG exhibited a negative association with prostate cancer risk in African Americans (OR=0.4; CI = 0.1-0.9; P=0.02) and European Americans (OR=0.2; CI=0.1-0.9; P=0.03). These data suggests that variation of the COX-2 promoter may influence the risk and development of prostate cancer.

Urology. 2004 Jan;63(1):90-4.

Low AUA symptom score independently predicts positive prostate needle biopsy: results from a racially diverse series of 411 patients.

Porter CR, Kim J.

Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington 98111, USA.

OBJECTIVES: To evaluate the prebiopsy parameters, including the American Urological Association symptom score (AUASS), that may be predictive of positive biopsy. Transrectal ultrasound (TRUS) biopsy of the prostate represents the reference standard in the diagnosis of prostate cancer. METHODS: A total of 411 consecutive men undergoing TRUS biopsy were prospectively evaluated. The indications for biopsy were abnormal digital rectal examination (DRE) findings and/or an elevated prostate-specific antigen (PSA) level. A single surgeon (C.R.P.) examined all the men. DRE and TRUS were each given a level of suspicion between 1 (low suspicion–smooth DRE, homogeneous TRUS) and 5 (high suspicion–hard DRE, hypoechoic lesion). A level of suspicion of 3 or greater was considered abnormal. The prebiopsy parameters examined included PSA level, age, race, biopsy history, prostate volume, TRUS-detected lesion, and AUASS. RESULTS: Of 411 men, 62% were African American and 38% were white. The mean PSA level was 11.6 ng/mL. The mean patient age was 65.3 years. Overall, 39% of men had abnormal DRE and 32% abnormal TRUS findings. The mean AUASS was 9.3. The positive biopsy rate was 40.8%. Univariate analysis demonstrated that age, PSA level, prostate volume, abnormal DRE findings, TRUS-detected lesion, and AUASS (less than 7, low) were all predictive of a positive biopsy (P <0.05). Race was not statistically significant (P = 0.38). Detailed analysis of the AUASS in the 411 men indicated that 41% had low symptom scores (less than 7), 32% had moderate scores (8 to 19), and 27% had severe scores (20 to 35). In the group of men with low symptom scores (n = 169), univariate analysis demonstrated that age, PSA level, prostate volume, and abnormal TRUS findings were all statistically significant predictors of positive biopsy (P <0.05). Multivariate analysis of the data from the 411 men demonstrated that age, PSA level, prostate volume, abnormal DRE findings, and low AUASS were all independent predictors of positive biopsy (P <0.05). CONCLUSIONS: In this prospective study, the independent predictors of positive TRUS biopsy included age, PSA level, prostate volume, abnormal DRE findings, and low AUASS. A low AUASS may be an important variable to consider when counseling patients before biopsy and when designing patient algorithms for prostate biopsy.

1: Urology. 2004 Jan;63(1):90-4.

Low AUA symptom score independently predicts positive prostate needle biopsy: results from a racially diverse series of 411 patients.

Porter CR, Kim J.

Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington 98111, USA.

OBJECTIVES: To evaluate the prebiopsy parameters, including the American Urological Association symptom score (AUASS), that may be predictive of positive biopsy. Transrectal ultrasound (TRUS) biopsy of the prostate represents the reference standard in the diagnosis of prostate cancer. METHODS: A total of 411 consecutive men undergoing TRUS biopsy were prospectively evaluated. The indications for biopsy were abnormal digital rectal examination (DRE) findings and/or an elevated prostate-specific antigen (PSA) level. A single surgeon (C.R.P.) examined all the men. DRE and TRUS were each given a level of suspicion between 1 (low suspicion–smooth DRE, homogeneous TRUS) and 5 (high suspicion–hard DRE, hypoechoic lesion). A level of suspicion of 3 or greater was considered abnormal. The prebiopsy parameters examined included PSA level, age, race, biopsy history, prostate volume, TRUS-detected lesion, and AUASS. RESULTS: Of 411 men, 62% were African American and 38% were white. The mean PSA level was 11.6 ng/mL. The mean patient age was 65.3 years. Overall, 39% of men had abnormal DRE and 32% abnormal TRUS findings. The mean AUASS was 9.3. The positive biopsy rate was 40.8%. Univariate analysis demonstrated that age, PSA level, prostate volume, abnormal DRE findings, TRUS-detected lesion, and AUASS (less than 7, low) were all predictive of a positive biopsy (P <0.05). Race was not statistically significant (P = 0.38). Detailed analysis of the AUASS in the 411 men indicated that 41% had low symptom scores (less than 7), 32% had moderate scores (8 to 19), and 27% had severe scores (20 to 35). In the group of men with low symptom scores (n = 169), univariate analysis demonstrated that age, PSA level, prostate volume, and abnormal TRUS findings were all statistically significant predictors of positive biopsy (P <0.05). Multivariate analysis of the data from the 411 men demonstrated that age, PSA level, prostate volume, abnormal DRE findings, and low AUASS were all independent predictors of positive biopsy (P <0.05). CONCLUSIONS: In this prospective study, the independent predictors of positive TRUS biopsy included age, PSA level, prostate volume, abnormal DRE findings, and low AUASS. A low AUASS may be an important variable to consider when counseling patients before biopsy and when designing patient algorithms for prostate biopsy.

: J Sex Marital Ther. 2004 Mar-Apr;30(2):79-93.

Sexuality and health-related quality of life after prostate cancer in african-american and white men treated for localized disease.

Jenkins R, Schover LR, Fouladi RT, Warneke C, Neese L, Klein EA, Zippe C, Kupelian P.

The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.

The purpose of this study was to examine differences in sexual attitudes and quality of life of White and African-American men who have undergone radical prostatectomy or radiation therapy for localized prostate cancer. Respondents included 1,112 White and 118 African-American men. Response rates differed by race, with 51% of White men and 28% of African-American men returning the questionnaire assessing demographics, medical history, sexual functioning, attitudes about seeking help for sexual problems, sexual self-schema, and health-related quality of life. African Americans were more likely than Whites to have undergone radiation therapy (p <.0001) and were more likely to indicate that a desire to maintain sexual functioning influenced their treatment choice (p <.0001). African-American men also had more positive attitudes than did White men toward seeking help for sexual problems and were more likely to report seeking past help and intending to seek future help. African-American men reported more problems with sexual desire (p =.0003), although their sexual function scores did not differ significantly from those of Whites. African-American men may be more at risk for distress when prostate cancer treatment causes sexual dysfunction.

Br J Cancer. 2004 Jan 26;90(2):510-4.

Hereditary prostate cancer in African American families: linkage analysis using markers that map to five candidate susceptibility loci.

Brown WM, Lange EM, Chen H, Zheng SL, Chang B, Wiley KE, Isaacs SD, Walsh PC, Isaacs WB, Xu J, Cooney KA.

Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.

African American men have the highest incidence of prostate cancer in the world. Despite this statistic, linkage studies designed to localise prostate cancer susceptibility alleles have included primarily men of Caucasian descent. In this report, we performed a linkage analysis using 33 African American prostate cancer families from two independent research groups. In total, 126 individuals (including 89 men with prostate cancer) were genotyped using markers that map to five prostate cancer susceptibility loci, namely HPC1 at 1q24-25, PCAP at 1q42.2-43, CAPB at 1p36, HPC20 on chromosome 20, and HPCX at Xq27-28. Multipoint mode-of-inheritance-free linkage analyses were performed using the GENEHUNTER software. Some evidence of prostate cancer was detected to HPC1 using all families with a maximum NPL Z score of 1.12 near marker D1S413 (P=0.13). Increased evidence of linkage was observed in the 24 families with prostate cancer diagnosis prior to age 65 years and in the 20 families with male-to-male transmission. Some evidence of prostate cancer linkage was also detected at markers mapping to PCAP, HPC20, and HPCX. Continued collection and analysis of African American prostate cancer families will lead to an improved understanding of inherited susceptibility in this high-risk group.

Clin Cancer Res. 2004 Jan 1;10(1 Pt 1):222-7.

Altered N-myc downstream-regulated gene 1 protein expression in African-American compared with caucasian prostate cancer patients.

Caruso RP, Levinson B, Melamed J, Wieczorek R, Taneja S, Polsky D, Chang C, Zeleniuch-Jacquotte A, Salnikow K, Yee H, Costa M, Osman I.

Department of Urology, New York University Cancer Institute, Kaplan Comprehensive Cancer Center, New York, USA.

PURPOSE: The protein encoded by N-myc downstream-regulated gene 1 (NDRG1) is a recently discovered protein whose transcription is induced by androgens and hypoxia. We hypothesized that NDRG1 expression patterns might reveal a biological basis for the disparity of clinical outcome of prostate cancer patients with different ethnic backgrounds. EXPERIMENTAL DESIGN: Patients who underwent radical prostatectomy between 1990 and 2000 at Veterans Administration Medical Center of New York were examined. We studied 223 cases, including 157 African Americans and 66 Caucasians (T2, n = 144; >/=T3, n = 79; Gleason <7, n = 122; >/=7, n = 101). Three patterns of NDRG1 expression were identified in prostate cancer: (a) intense, predominately membranous staining similar to benign prostatic epithelium; (b) intense, nucleocytoplasmic localization; and (c) low or undetectable expression. We then examined the correlations between patients’ clinicopathological parameters and different NDRG1 expression patterns. RESULTS: In this study of patients with equal access to care, African-American ethnic origin was an independent predictor of prostate-specific antigen recurrence (P < 0.05). We also observed a significant correlation between different patterns of NDRG1 expression and ethnic origin. Pattern 2 was less frequent in African Americans (21% versus 38%), whereas the reverse was observed for pattern 3 (60% in African Americans versus 44% in Caucasians; P = 0.03). This association remained significant after controlling for both grade and stage simultaneously (P = 0.02). CONCLUSIONS: Our data suggest that different NDRG1 expression patterns reflect differences in the response of prostatic epithelium to hypoxia and androgens in African-American compared with Caucasian patients. Further studies are needed to determine the contribution of NDRG1 to the disparity in clinical outcome observed between the two groups.

Oncogene. 2004 Jan 15;23(2):605-11.

Elevated expression of PCGEM1, a prostate-specific gene with cell growth-promoting function, is associated with high-risk prostate cancer patients.

Petrovics G, Zhang W, Makarem M, Street JP, Connelly R, Sun L, Sesterhenn IA, Srikantan V, Moul JW, Srivastava S.

Department of Surgery, Center for Prostate Disease Research, US Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA. gpetrovics@cpdr.org

PCGEM1 is a novel, highly prostate tissue-specific, androgen-regulated gene. Here, we demonstrate that PCGEM1 expression is significantly higher in prostate cancer (CaP) cells of African-American men than in Caucasian-American men (P=0.0002). Further, increased PCGEM1 expression associates with normal prostate epithelial cells of CaP patients with a family history of CaP (P=0.0400). PCGEM1 overexpression in LNCaP and in NIH3T3 cells promotes cell proliferation and a dramatic increase in colony formation, suggesting a biological role of PCGEM1 in cell growth regulation. Taken together, the cell proliferation/colony formation-promoting functions of PCGEM1 and the association of its increased expression with high-risk CaP patients suggest the potential roles of PCGEM1 in CaP onset/progression, especially in these high-risk groups.

1: Mil Med. 2003 Dec;168(12):992-6.

Health practices of male Department of Defense health care beneficiaries: a follow-up on prostate cancer screening in the national capital area.

Boyles G, Moore AD, Edwards QT.

Naval Hospital Guam, Family Practice Clinic, PSC 490 Box 7638, FPO AP 96938-1600.

The purpose of this study was to assess screening for prostate cancer (PC) of male Department of Defense health care beneficiaries in the national capital area. This study was a follow-up of a previous research of African-American men’s PC screening practices. In the previous study, 85% of African-American men screened for PC and the determinants of screening were men’s perceived “benefits” of PC testing, age, and education. This follow-up study was conducted on 234 men age 52 years and over regardless of ethnicity using a questionnaire and convenience sampling similar to the prior study. Results showed 96% screened for PC; no statistical differences in PC screening and ethnicity; and men’s perceived “self-efficacy” and “benefits” were predictors of PC screening. More men screened for PC when advised by their health care providers and 94% of men stated “trust” in health care providers, indicating the importance of a “trusting-informative health care milieu” for men’s self-efficacy to screen for PC.

Urology. 2003 Dec 22;62(6 Suppl 1):3-12.

Epidemiology of prostate cancer.

Crawford ED.

Section of Urologic Oncology, Division of Urology, University of Colorado Health Science Center and the University of Colorado Cancer Center, Denver, Colorado 80262, USA. david.crawford@uchsc.edu

Prostate cancer incidence and mortality rates vary worldwide. In the United States, prostate cancer is the most common malignancy affecting men and is the second-leading cause of cancer death. Risk of developing prostate cancer is associated with advancing age, African American ethnicity, and a positive family history, and may be influenced by diet and other factors. The incidence of prostate cancer increased sharply after the introduction of widespread screening for prostate-specific antigen (PSA), although rates have now returned to levels seen before that time. PSA screening has been associated with a shift toward diagnosis of earlier-stage disease, but this has not been accompanied by a shift toward a lower histologic grade. Although overall prostate cancer mortality rates decreased during the 1990s, it was largely because of reductions in deaths among men diagnosed with distant disease. In contrast, mortality rates for men diagnosed with localized or regional disease increased gradually during most of the 1990s before decreasing slightly among white men and reaching plateaus among African Americans.

Urol Oncol. 2003 Nov-Dec;21(6):483-4.

Trends in prostate cancer mortality among black men and white men in the United States. Chu KC, Tarone RE, Freeman HP, Center to Reduce Cancer Health Disparities, National Cancer Institute, Bethesda, MD. Cancer 2003;97:1507-1516.

Carroll PR.

Prostate cancer mortality rates in the United States declined sharply after 1991 in White men and declined after 1992 in African American men. The current study was conducted to investigate possible mechanisms for the declining prostate cancer mortality rates in the United States.The authors examined and compared patterns of prostate cancer incidence, survival rates, and mortality rates among African American men and White men in the United States using the 1969-1999 U.S. prostate cancer mortality rates and the 1975-1999 prostate cancer incidence, survival, and incidence-based mortality rates from the Surveillance, Epidemiology, and End Results (SEER) Program for the U.S. population. The SEER data represent approximately 10% of the U.S. population.Prostate cancer incidence and mortality rates showed transient increases after 1986, when the U.S. Food and Drug Administration approved the use of prostate specific antigen (PSA) testing. The age-adjusted prostate cancer mortality rates for men age 50 to 84 years, however, have dropped below the rate in 1986 since 1995 for White men and since 1997 for African American men. In fact, for White men ages 50-79 years, the 1998 and 1999 rates were the lowest observed since 1950. Incidence-based mortality rates by disease stage revealed that the recent declines were because of declines in distant disease mortality. Moreover, the decrease in distant disease mortality was because of a decline in distant disease incidence, and not to improved survival of patients with distant disease.Similar incidence, survival, and mortality rate patterns are seen in African American men and White men in the United States, although with differences in the timing and magnitude of recent rate decreases. Increased detection of prostate cancer before it becomes metastatic, possibly reflecting increased use of PSA testing after 1986, may explain much of the recent mortality decrease in both white men and black men.

: Health Soc Work. 2003 Nov;28(4):302-11.

Prostate cancer and psychosocial concerns in African American men: literature synthesis and recommendations.

Pierce R, Chadiha LA, Vargas A, Mosley M.

University of Michigan School of Social Work, Ann Arbor, MI, USA. billybob@gwbmail.wustl.edu

African American men have the highest prostate cancer rates in the world, and more die from the disease than men from other racial or ethnic groups. Because the social work literature has little information on prostate cancer in African American men, the authors have synthesized the literature on prostate cancer and psychosocial concerns in African American men. They used the Health Belief Model as a framework to help explain, understand, and predict African American men’s preventive health-related behaviors. The authors make recommendations for social work practice and research.

Ethn Dis. 2003 Fall;13(4):470-6.

Barriers and strategies for sustained participation of African-American men in cohort studies.

Hoyo C, Reid ML, Godley PA, Parrish T, Smith L, Gammon M.

Department of Health Education, North Carolina Central University, Durham 27707, USA. hoyo0001@mc.duke.edu

BACKGROUND: Prostate cancer incidence is about 70% higher among African Americans compared to Whites. Factors associated with this differential remain unclear, although several studies suggest that genetic factors may play a role. Before epidemiologic research can adequately identify factors associated with this differential, we need studies to determine the feasibility of recruiting and retaining African-American men in cohort studies, especially those that collect biological and questionnaire data. METHODS: We conducted 4 focus group discussions among African-American men aged 40 to 64 years in North Carolina, and an additional group comprised of their partners, using a semi-structured interview protocol (total N=55 subjects). Data were analyzed with QRS NU*DIST to identify themes. RESULTS: Participants’ willingness to participate in cohort studies seemed to be motivated by a perceived risk of prostate cancer. Barriers to participation included mistrust of the research community, poor knowledge of cancer-site specific heterogeneity, anticipated time commitment, and the invasive nature of disease detection procedures. To foster trust and increase disease knowledge, recommended strategies included: partnering with known civic organizations that provide education on risk factors; discussing early signs and symptoms at the point of recruitment; recruiting participants from community clusters; and providing periodic feedback on biologic samples (if collected) to reassure participants of their proper usage. CONCLUSION: Observational cohort studies focused on African-American men are feasible if certain barriers to participation are addressed.

Int J Radiat Oncol Biol Phys. 2003 Dec 1;57(5):1292-6.

The association between presentation PSA and race in two sequential time periods in prostate cancer patients seen at a university hospital and its community affiliates.

Pan CC, Lee JS, Chan JL, Sandler HM, Underwood W, McLaughlin PW.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109, USA. cpan@umich.edu

PURPOSE: We sought to determine whether African American men diagnosed with prostate cancer in the prostate-specific antigen (PSA) era differed in initial presenting serum PSA levels (iPSA) compared to white men. Recent retrospective studies have demonstrated higher iPSA within the African American men than in white men at the time of diagnosis, suggestive of more advanced disease in African American men. Both biologic differences and/or sociologic factors have been postulated as explaining the noted differences in iPSA. We reviewed our institution’s PSA-era experience to determine any association between race and iPSA. MATERIALS AND METHODS: Between January 1990 and September 2001, 4519 patients representing a broad demographic sample were seen in the radiation oncology department of a university hospital or one of its four community affiliates. A total of 2332 eligible patients, with data on race, age, year of diagnosis, Gleason score, T stage, and iPSA, were analyzed. The patients were separated into the two following time periods for analysis, based on the new American Cancer Society screening guidelines: (1) 1991 to 1996 and (2) 1997 to 2001. The relationships between race and iPSA, T stage, Gleason score, and age are explored. RESULTS: Of the 2332 patients analyzed, there were 1968 white men and 364 African American men. For the time period 1990 through 1996, the expected average (median) iPSA level was 10.5 (10.2) and 14.6 (15.8) for white men and African American men, respectively. For 1997 to 2001, the expected average iPSA level was 9.5 (8.4) and 10.8 (9.8), respectively. T stage distributions improved, independent of race, toward earlier stage at presentation. Gleason score distribution remained unchanged. African American men are 2.5-3.1 years younger than white men at diagnosis. CONCLUSIONS: An overall decline in iPSA has occurred in both racial groups over time. More importantly, racial differences in iPSA among men diagnosed in the later time period (1997 to 2001) are less pronounced compared to men diagnosed in the earlier time period (1990 to 1996). This racial convergence in iPSA over time suggests improved penetrance of PSA screening in the African American population. Our findings also suggest that studies comparing racial differences in iPSA should consider time period of diagnosis and possible sociologic changes during that period (i.e., access to medical care, socioeconomic status, and educational level). The American Cancer Society guideline to begin screening African Americans at an earlier age is appropriate.

Urology. 2003 Nov;62(5):835-9.

Complexed PSA performance for prostate cancer detection in an African-American population.

Martin B, Cheli CD, Lifsey D, Ward M, Pollard S, Jefferson L, Thiel RP, Rayford W.

Louisiana State University Medical Center, New Orleans, Louisiana 70112, USA.

OBJECTIVES: Complexed prostate-specific antigen (cPSA) has been shown to improve the differentiation of benign and malignant disease compared with total PSA (tPSA) in studies evaluating predominantly white populations of men. We sought to evaluate the diagnostic performance of cPSA relative to tPSA in a population of African-American men. METHODS: Consecutive African-American men scheduled for prostate biopsy were enrolled prospectively at the Louisiana State University Medical Center, New Orleans. Serum was collected before the biopsy procedure and tested with the Immuno 1 tPSA and cPSA methods. Receiver operating characteristic curve analysis was performed and the area under the curve was calculated for tPSA and cPSA. RESULTS: A total of 156 patients were evaluated, 51 (32.7%) of whom were diagnosed with prostate cancer. The median PSA value for men with prostate cancer was 4.96 ng/mL and for those with benign disease was 3.93 ng/mL. The receiver operating characteristic analysis indicated that the area under the curve for cPSA (0.679) was statistically greater than that achieved for tPSA (0.642, P = 0.004). Using cutoff values for cPSA of 2.3 ng/mL and for tPSA of 2.85 ng/mL provided a specificity of 31.4% and 26.7%, respectively, at a sensitivity for prostate cancer detection of 95%. This was not statistically significant (P = 0.18). CONCLUSIONS: cPSA offers modest improvement in prostate cancer detection compared with tPSA in African-American men, but not at the clinically relevant 95% sensitivity level. Additional work is needed to improve prostate cancer detection in this high-risk cohort of patients.

1: J Natl Med Assoc. 2003 Oct;95(10):951-4.

Spirituality and care of prostate cancer patients: a pilot study.

Bowie J, Sydnor KD, Granot M.

Department of Health Policy and Management, Faculty of Social and Behavioral Sciences, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA. jbowie@jhsph.edu

PURPOSE: To explore the integration of spirituality into medical care for African-American men coping with prostate cancer. PROCEDURES: A total of 14 African-American prostate cancer patients completed a self-administered quantitative survey examining the dimension of spirituality as a resource for coping. FINDINGS: A high proportion of survivors reported a general religious orientation as expressed through church affiliation and frequent church attendance. A majority (67%) had spoken with their doctors about their spiritual and religious beliefs and more than half the physicians had solicited their patients’ spiritual beliefs as part of their handling of prostate cancer. While one-third of the men reported their doctors had been in contact with their clergy, two-thirds would like their doctor and clergy to be in contact with one another. CONCLUSIONS: This is a pilot study that incorporated both qualitative and quantitative data collection but with the small sample, has limited generalizability. However, this work does suggest that integrating spirituality and religion into medical care may be beneficial to prostate cancer patients. Physicians and physician organizations should engage in future research in this area.

1: J Clin Epidemiol. 2003 Nov;56(11):1064-75.

The development and validation of a comorbidity index for prostate cancer among Black men.

Fleming ST, Pearce KA, McDavid K, Pavlov D.

Health Services Management, University of Kentucky, 121 Washington Avenue, Room 113C, Lexington, KY 40536-0003, USA. stfelm2@pop.uky.edu

BACKGROUND AND OBJECTIVES: The purpose of this study was to develop a comorbidity index specific to Black Men with prostate cancer, because certain comorbidities and prostate cancer are particularly prevalent among this racial group. METHODS: This research used the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database to develop an index of comorbidity burden based on survival, and the presence/absence of comorbid illness in 2,931 Black males diagnosed with prostate cancer. Comorbidity burden was recognized using inpatient, outpatient, and physician claims for a 2-year period prior to the diagnosis of prostate cancer. We compared five different statistical models, each with two-way, three-way, and/or four-way interactions among the comorbidities, and selected the model with only two-way interactions as the optimal choice. We demonstrated the utility of refining the simplest model, with 27 comorbidity categories only, by adjusting for the number of different diagnoses within statistically significant categories.

: Oncol Nurs Forum. 2003 Nov-Dec;30(6):967-75.

Focus groups in the design of prostate cancer screening information for Hispanic farmworkers and African American men.

Meade CD, Calvo A, Rivera MA, Baer RD.

Department of Interdisciplinary Oncology, University of South Florida, Tampa, FL, USA. cdmeade@moffitt.usf.edu

PURPOSE/OBJECTIVES: To gain a better understanding of men’s everyday concerns as part of formative research for creating relevant prostate cancer screening education; to describe methods and processes used to conduct community-based focus groups. SETTING: Community-based settings in catchment areas surrounding Tampa, FL. SAMPLE: 8 community-based focus groups: a total of 71 Hispanic farmworkers and African American men. METHODS: Focus group discussions were tape-recorded, transcribed, and analyzed for identification of emergent themes. MAIN RESEARCH VARIABLES: General life and health priorities, prostate cancer knowledge, screening attitudes, cancer beliefs, and learning preferences. FINDINGS: Major themes among African American men were importance of work, family, and faith. Major themes among Hispanic farmworkers were importance of family, employment, education of children, and faith. A common issue that surfaced among most men was that a cancer diagnosis was considered to be a death sentence. Preferred learning methods included use of cancer survivors as spokespeople, interactive group education, and the provision of easy-to-understand information. Issues of trust, respect, and community involvement were key to the successful conduct of focus groups among ethnically diverse groups. CONCLUSIONS: Study findings have important implications for the content of information developed for prostate cancer education materials and media. IMPLICATIONS FOR NURSING: Insights gained from focus group methodology can help nurses and other healthcare professionals design and develop appropriate prostate cancer education tools for use in community-based prostate cancer screening programs.

J Gen Intern Med. 2003 Oct;18(10):845-53.

Racial differences in initial treatment for clinically localized prostate cancer. Results from the prostate cancer outcomes study.

Hoffman RM, Harlan LC, Klabunde CN, Gilliland FD, Stephenson RA, Hunt WC, Potosky AL.

Medicine Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. rhoffman@unm.edu

OBJECTIVE: We examined whether there were racial differences in initial treatment for clinically localized prostate cancer and investigated whether demographic, socioeconomic, clinical, or tumor characteristics could explain any racial differences. DESIGN: Prospective cohort study. SETTING: Population-based tumor registries in Connecticut, Los Angeles, and Atlanta. PARTICIPANTS: We evaluated 1144 African-American and non-Hispanic white men, aged 50 to 74 years, with clinically localized cancer diagnosed between October 1994 and October 1995. MEASUREMENTS AND MAIN RESULTS: We obtained demographic, socioeconomic, and clinical data from patient surveys and medical record abstractions. We reported adjusted percentages for receiving treatment derived from multinomial logistic regression. We found an interaction between race and tumor aggressiveness. Among men with more aggressive cancers (PSA > or = 20 ng/mL or Gleason score > or = 8), African Americans were less likely to undergo radical prostatectomy than non-Hispanic whites (35.2% vs 52.0%), but more likely to receive conservative management (38.9% vs 16.3%, P=.003). Among the 71% of subjects with less aggressive cancers, African Americans and non-Hispanic whites were equally likely to receive either radical prostatectomy or radiation therapy (80.0% vs 84.5%, P=.2). CONCLUSIONS: African Americans with more aggressive cancers were less likely to undergo radical prostatectomy and more likely to be treated conservatively. These treatment differences may reflect African Americans’ greater likelihood for presenting with pathologically advanced cancer for which surgery has limited effectiveness. Among men with less aggressive cancers-the majority of cases-there were no racial differences in undergoing radical prostatectomy or radiation therapy.

J Gen Intern Med. 2003 Oct;18(10):845-53.

Racial differences in initial treatment for clinically localized prostate cancer. Results from the prostate cancer outcomes study.

Hoffman RM, Harlan LC, Klabunde CN, Gilliland FD, Stephenson RA, Hunt WC, Potosky AL.

Medicine Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. rhoffman@unm.edu

OBJECTIVE: We examined whether there were racial differences in initial treatment for clinically localized prostate cancer and investigated whether demographic, socioeconomic, clinical, or tumor characteristics could explain any racial differences. DESIGN: Prospective cohort study. SETTING: Population-based tumor registries in Connecticut, Los Angeles, and Atlanta. PARTICIPANTS: We evaluated 1144 African-American and non-Hispanic white men, aged 50 to 74 years, with clinically localized cancer diagnosed between October 1994 and October 1995. MEASUREMENTS AND MAIN RESULTS: We obtained demographic, socioeconomic, and clinical data from patient surveys and medical record abstractions. We reported adjusted percentages for receiving treatment derived from multinomial logistic regression. We found an interaction between race and tumor aggressiveness. Among men with more aggressive cancers (PSA > or = 20 ng/mL or Gleason score > or = 8), African Americans were less likely to undergo radical prostatectomy than non-Hispanic whites (35.2% vs 52.0%), but more likely to receive conservative management (38.9% vs 16.3%, P=.003). Among the 71% of subjects with less aggressive cancers, African Americans and non-Hispanic whites were equally likely to receive either radical prostatectomy or radiation therapy (80.0% vs 84.5%, P=.2). CONCLUSIONS: African Americans with more aggressive cancers were less likely to undergo radical prostatectomy and more likely to be treated conservatively. These treatment differences may reflect African Americans’ greater likelihood for presenting with pathologically advanced cancer for which surgery has limited effectiveness. Among men with less aggressive cancers-the majority of cases-there were no racial differences in undergoing radical prostatectomy or radiation therapy.:

J Cult Divers. 2003 Summer;10(2):56-61.

Prostate cancer in black men of African-Caribbean descent.

Kleier JA.

Barry University, Miami Shores, FL, USA. jkleier@mail.barry.edu

Prostate cancer is a significant health problem for middle-aged and elderly men. In the United States (US), it is the most frequently diagnosed cancer and is the second leading cause of cancer death. While men of all racial and ethnic backgrounds are at risk, black men of African descent are at especially high risk. African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world. The term “African-American” has been used to describe all black people living in the US. Use of such broad categorization ignores the existence of subcultures within the black community. While members of the black race may share similar primary, genetic characteristics, skin color cannot be equated with attitudes, knowledge, and behaviors of particular cultural groups. Therefore, prostate cancer interventions developed for African-American men may not be effective for men of African-Caribbean descent.

Appl Immunohistochem Mol Morphol. 2003 Sep;11(3):253-60.

Prostate cancer in African American men is associated with downregulation of zinc transporters.

Rishi I, Baidouri H, Abbasi JA, Bullard-Dillard R, Kajdacsy-Balla A, Pestaner JP, Skacel M, Tubbs R, Bagasra O.

University of South Carolina Cancer Research Center, Columbia, SC, USA.

In the United States, prostate cancer is the most commonly diagnosed male cancer and the second leading cause of all male cancer deaths. Furthermore, incidence rates are higher in African Americans than in any other racial group. Our laboratory is attempting to decipher the environmental and molecular mechanisms involved in the development of prostate cancer in African Americans. Because Africa is a mineral-rich continent, and the zinc levels in the water and diet are high, it is hypothesized that Africans may have genetically downregulated their zinc absorption capacity; otherwise, they would absorb abnormally high levels of zinc, resulting in various serious neurodegenerative and biochemical disorders. It is therefore possible that people of African origin may have a lower capacity to absorb zinc when compared with other racial groups because of their inherent downregulation of zinc transporters. Extensive research has shown that low serum levels of zinc are associated with the increased incidence of prostate cancer. We have evaluated 58 prostate cancer tissues in 2 major racial groups (30 from whites and 28 from African Americans) for their ability to express 2 major human zinc transporters, hZIP1 and hZIP2. In all 30 prostate cancer specimens obtained from white people, the degree of expression of these 2 zinc receptors was high when compared with age-matched and Gleason score-matched specimens obtained from African American patients. We also found a significant downregulation of these 2 zinc transporters in normal prostate tissues from African American men when compared with age-matched white men. The loss of the unique ability to retain normal intracellular levels of zinc may be an important factor in the development and progression of prostate cancer. Our observation that the uptake of zinc may be different in racial groups is intriguing and relevant. Once these data are confirmed in larger groups, this finding could have significant application as a preventive maneuver for at least for some people. Because dietary zinc supplements are relatively nontoxic, any efficacy trial would be low-risk.

J Natl Med Assoc. 2003 Jul;95(7):618-25.

African American men, prostate cancer screening and informed decision making.

Sellers DB, Ross LE.

Duke University Medical Center, Durham, NC 27710, USA. selle006@mc.duke.edu

Prostate cancer is the second leading cause of cancer deaths in African American men. African Americans are at increased risk over other groups and have higher mortality. Since prostate cancer is highly variable among men, medical organizations are not in agreement whether men should be screened or the appropriate ages to screen. Many of these organizations recommend discussion with patients about the benefits and limitations of screening. Some of these groups support informed decision-making (IDM). Through IDM, the patient obtains all of the information about prostate cancer including risk, to make an informed choice regarding screening. Due to several factors including lowered engagement of African American men in the healthcare system, disparities in treatment, increased risk in developing and dying from the disease, as well as other cultural and structural constraints, IDM is examined and proposed as an appropriate tool for African American men. The use of IDM is discussed, along with several challenges and cautions. We conclude with recommendations and suggestions to the provider and patient to facilitate discussions regarding prostate cancer.

Cancer. 2003 Aug 1;98(3):496-503.

Race independently predicts prostate specific antigen testing frequency following a prostate carcinoma diagnosis.

Zeliadt SB, Penson DF, Albertsen PC, Concato J, Etzioni RD.

Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.

BACKGROUND: The goals of the current study were to describe patterns of prostate specific antigen (PSA) surveillance for prostate carcinoma progression in a community-based cohort of patients and to identify independent clinical and sociodemographic factors that predict the frequency of surveillance. METHODS: Patients diagnosed with localized prostate carcinoma from October 1, 1991 to December 31, 1992 in New Haven and Hartford, Connecticut, were identified. Data were collected through standardized outpatient medical record review. Multivariate statistical methods were used to determine the factors that independently predicted the frequency of surveillance. RESULTS: Six hundred fifty-eight men with localized prostate carcinoma were included in the cohort. Forty-five percent of all patients were tested at least once annually, and 69% were tested at least once every 2 years. Multivariate models indicated that African American men were half as likely as Caucasian men to receive annual testing (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.24-0.97). Men diagnosed at age 70 years or older were 38% less likely to have annual testing than men diagnosed between the ages of 65 and 69 (OR, 0.62; 95% CI, 0.41-0.94). A higher Gleason score and PSA at presentation also were associated independently with higher rates of annual PSA surveillance. CONCLUSIONS: Postdiagnosis PSA surveillance is common, although not universal. African American men were at significantly greater risk for receiving less frequent testing compared with Caucasian men. This disparity in access to care may explain, in part, previously observed racial differences in survival in prostate carcinoma. Further research is needed to identify the reasons for the racial disparity in PSA surveillance and to design interventions to lessen these differences.

Prostate. 2003 Sep 1;56(4):256-62.

Familial aggregation of prostate cancer in African-Americans and white Americans.

Cunningham GR, Ashton CM, Annegers JF, Souchek J, Klima M, Miles B.

Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA. Cunningham.glennr@med.va.gov

BACKGROUND: We compared the incidence of prostate cancer in first-degree family members of African-Americans with that in white Americans. METHODS: A historical cohort design was used to enroll 330 incident cases <80 years of age that were diagnosed at the Houston VA Medical Center between June 9, 1993 and June 8, 1996. We compared incidence rates in the probands’ families with the incidence rates found in contemporaneous data from the national and regional Surveillance, Epidemiology, and End-Results (SEER) program. RESULTS: Three-hundred five probands (41% African-American) had evaluable first-degree relatives (394 African-American, 527 non-African-American). The standardized incidence ratio was 1.61 overall (95% confidence interval (CI): 1.22-2.13) and did not differ between African-American and non-African-American families: 1.58 (1.05-2.29) and 1.65 (1.06-2.45) in African-Americans and non-African-Americans, respectively. CONCLUSIONS: The similar level of familial aggregation is evidence that the higher incidence of prostate cancer in African-Americans is not attributable to a higher prevalence of germline mutations predisposing to the disease. Copyright 2003 Wiley-Liss, Inc.

Clin Cancer Res. 2003 Jul;9(7):2613-9.

Altered expression of p27 and Skp2 proteins in prostate cancer of African-American patients.

Drobnjak M, Melamed J, Taneja S, Melzer K, Wieczorek R, Levinson B, Zeleniuch-Jacquotte A, Polsky D, Ferrara J, Perez-Soler R, Cordon-Cardo C, Pagano M, Osman I.

Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

PURPOSE: The purpose is to investigate the clinical relevance of altered patterns of p27 and Skp2 expression in African-American patients with localized prostate cancer. The abundance of p27, an inhibitor of cell proliferation, is controlled by Skp2-dependent proteolysis. EXPERIMENTAL DESIGN: A well-characterized cohort of 162 African-Americans who underwent radical prostatectomy at the Veterans Affairs Medical Center of New York between 1990 and 2000 was studied. We analyzed p27 and Skp2 expression by immunohistochemistry. Altered expression of p27 (defined as <40% tumor cells expressing the protein) and Skp2 (defined as > or ==” BORDER=”0″>20% tumor cells expressing the protein) were correlated with clinicopathological parameters and time to prostate-specific antigen (PSA) recurrence. RESULTS: Altered expression of p27 and Skp2 was observed in 112 of 162 (69.1%) and 93 of 162 (57.4%) cases, respectively. Inverse patterns of Skp2 and p27 protein expression were seen in 87 of 162 (53.7%) cases. A marginally significant association was found between Skp2 overexpression and extracapsular extension (P = 0.065). Moreover, patients with Skp2 overexpression had a 2.77 years decreased median time to PSA recurrence compared with patients with low Skp2 expression; however, the difference was not statistically significant. In multivariate analysis, only tumor grade and stage independently predicted PSA recurrence in this cohort. CONCLUSIONS: Our data suggest a role for Skp2 overexpression in prostate cancer pathogenesis that might not be exclusively related to p27 degradation. More studies are needed to determine the mechanistic role of Skp2 in prostate cancer.

: Cancer Res. 2003 Jul 1;63(13):3486-9.

Germ-line mutations of the macrophage scavenger receptor 1 gene: association with prostate cancer risk in African-American men.

Miller DC, Zheng SL, Dunn RL, Sarma AV, Montie JE, Lange EM, Meyers DA, Xu J, Cooney KA.

Department of Urology, University of Michigan, Medical School, Ann Arbor, Michigan 48109-0946, USA.

Both rare germ-line mutations and common sequence variants of the macrophage scavenger receptor 1 (MSR1) gene have recently been implicated as potential prostate cancer susceptibility factors. However, existing studies are limited by the referral-based nature of samples and a paucity of African-American participants. In this context, we evaluated the association of germ-line mutations and common MSR1 sequence variants with prostate cancer risk in a case control study of a community-based sample of 134 African-American men with prostate cancer and 340 unaffected controls. In our sample, the rare Asp174Tyr missense change was identified nearly twice as frequently in men with prostate cancer (6.8%) compared with unaffected controls (3.6%; P = 0.14). Moreover, significantly different allele frequencies between cases and controls were observed for one of the sequence variants, IVS5-59 (P = 0.02). Taken together, our results provide some additional support for the hypothesis that selected, rare MSR1 mutations are associated with increased prostate cancer susceptibility among African-American men.

Prostate Cancer Prostatic Dis. 2003;6(2):163-8.

cPSA and fPSA elimination in African-American men.

Martin BJ, Cheli C, Davis R, Ward M, Kokatnur M, Mercante D, Lifsey D, Rayford W.

Department of Urology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.

In all, 22 African-American males undergoing radical prostatectomy for prostate adenocarcinoma had serum drawn for tPSA, cPSA, and total protein concentrations prior to, during, and after operation to determine the respective elimination rates. African-American cPSA was found to fit best a simple first-order exponential elimination kinetic, with a half-life of 44.6 h. fPSA followed a two-compartment elimination with an alpha-phase elimination of 0.50 h and a beta-phase half-life of 4.2 h. Our results suggest higher rates of elimination for both cPSA and fPSA in an African-American male population with respect to Caucasians and may account for differences in PSA values between races.

Ethn Dis. 2003 Spring;13(2):220-5.

Black-white differences in survival from late-stage prostate cancer.

Polednak AP.

Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, Connecticut 06134, USA. anthony.polednak@po.state.ct.us

OBJECTIVE: To examine differences between African Americans (Blacks) and non-Hispanic Whites in risk of death after diagnosis of later-stage prostate cancer in a large sample of patients from US population-based cancer registries. The theory that Black patients with advanced cancer have a lower survival rate compared to their White counterparts, based on a single clinical trial, was tested with large samples of patients. METHODS: The Cox proportional hazards regression model was used to compare survival rates among 24,136 non-Hispanic White, and 3,817 Black prostate cancer patients diagnosed between 1988 and 1997, whose cancer had spread beyond the prostate capsule, and who resided in 9 geographic areas covered by the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program of population-based cancer registries. Other analyses involved 5- and 10-year relative survival rates (RSRs) among non-Hispanic White and Black patients diagnosed with distant-stage prostate cancer from 1973 to 1994 (with almost all patients having had a chance to survive for at least 5 years). RESULTS: The risk of death from prostate cancer was only slightly higher for Blacks than for Whites (adjusted hazard rate ratio = 1.05), when age, extent of disease, tumor grade, marital status, and surgery were included in the Cox proportional hazards regression model. Five- and 10-year RSRs were about 2%-22% higher for Blacks and Whites in strata defined by extent of disease, or among patients with distant stage cancer, but differences were small among married patients. CONCLUSIONS: The findings do not indicate substantial Black-White differences in survival rates of later-stage prostate cancer patients, after adjusting for clinical characteristics and marital status.

Cancer Metastasis Rev. 2003 Mar;22(1):83-6.

Prostate cancer in black and white Americans.

Reddy S, Shapiro M, Morton R Jr, Brawley OW.

Winship Cancer Institute, Emory University, Atlanta, Georgia, USA. kanthi_reddy@hotmail.com

The prostate cancer incidence and mortality of black Americans is among the highest in the world. The reasons have not been adequately explained. Similar disparities have been noted for men of sub-Saharan origin living in Brazil and the Caribbean. Avenues of investigation have assessed racial and ethnic differences in diet as well as possible differences in the prevalence of genetics (both polymorphisms and mutations). There are studies to suggest that there are no racial differences in outcome when there is equal treatment. Several studies show that there are racial differences in patterns of care in the US and it has been hypothesized that this contributes to some of the racial disparity in survival after diagnosis.

: J Natl Med Assoc. 2001 Apr;93(4):120-3.

African-American heredity prostate cancer study: a model for genetic research.

Powell IJ, Carpten J, Dunston G, Kittles R, Bennett J, Hoke G, Pettaway C, Weinrich S, Vijayakumar S, Ahaghotu CA, Boykin W, Mason T, Royal C, Baffoe-Bonnie A, Bailey-Wilson J, Berg K, Trent J, Collins F.

Dept of Urology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.

A genome-wide scan of high-risk prostate cancer families in North America has demonstrated linkage of a particular marker to Chromosome 1q (HPC1). An even greater proportion of African-American families have shown linkage to HPC1. Therefore, investigators at the National Human Genome Research Institute (NHGRI) in collaboration with Howard University and a predominantly African-American group of urologists established the African-American Hereditary Prostate Cancer (AAHPC) Study Network to confirm the suggested linkage of HPC in African Americans with a gene on Chromosome 1. Blood samples from recruited families were sent to Howard University for extraction of DNA. The DNA was sent to NHGRI at NIH where the genotyping and genetic sequence analysis was conducted. Genotype data are merged with pedigree information so that statistical analysis can be performed to establish potential linkage. From March 1, 1998, to June 1, 1999, a total of 40 African-American families have been recruited who met the study criteria. Preliminary results suggest that racial/ethnicity grouping may affect the incidence and extent of linkage of prostate cancer to specific loci. The importance of these findings lays in the future treatment of genetic-based diseases.

Urology. 2003 Feb;61(2):308-13.

Educating African-American men about prostate cancer: impact on awareness and knowledge.

Wilkinson S, List M, Sinner M, Dai L, Chodak G.

Weiss Memorial Hospital, University of Chicago Pritzker School of Medicine, Chicago, IL 60640, USA.

OBJECTIVES: To determine whether an education program on prostate cancer could improve awareness and knowledge among African-American men. African-American men have the world’s highest incidence of prostate cancer and more than twice the mortality compared with white men. Screening programs for prostate cancer have not been successful in attracting African-American participation. One explanation is a poor awareness and knowledge about the disease among this high-risk population. METHODS: We surveyed 900 African-American adults attending prostate cancer education seminars in community settings throughout Illinois between March 1998 and January 2001. Participants were asked to complete a multiple-choice questionnaire on topics related to prostate cancer. The main outcome measures were a change in awareness and knowledge of prostate cancer after the 1-hour educational seminar. RESULTS: The mean survey score improved from 26.0% before the seminar to 73.3% after it (P <0.0001). Every multiple-choice question was answered correctly more often after the seminar than before it. Increasing levels of education and income were associated with higher before and after scores (P <0.001). Men achieved a significantly greater score improvement (mean 48.1%) compared with women (mean 41.1%; P = 0.006). Previous screening for prostate cancer was reported by 23% of the participants. Using logistic regression analyses, higher levels of education and income correlated with higher rates of screening. After the seminar, 63.1% stated the intention to undergo screening. CONCLUSIONS: Our results demonstrate that prostate cancer awareness and knowledge can improve dramatically after a 1-hour seminar on the topic. Additional studies to evaluate the long-term retention of knowledge and impact on behavior are warranted.

Prostate Cancer Prostatic Dis. 2000 Dec;3(4):248-255.

Targeted screening for prostate cancer in African-American men.

Moul JW.

Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC and Center for Prostate Disease Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

African-American men and black men throughout the world have a higher rate of prostate cancer than other ethnic groups. They also are most likely to present at a younger age with more advanced disease and have historically had a poorer prognosis. Whether this observed difference is due to behavior, lack of access, environmental factors or genetics is hotly debated. Whatever the cause or causes, there is growing concensus that targeting screening to this high-risk group is justified. Focused education about risk and screening in black men can be effective and demonstration screening programs in African-American community settings have been successful. There is much debate about the proper normal values of PSA to be used in screening high risk black men. Some have argued for a very low normal range such as

Public Health Rep. 2001 Nov-Dec;116(6):590-8.

Improving knowledge of the prostate cancer screening dilemma among African American men: an academic-community partnership in Washington, DC.

Taylor KL, Turner RO, Davis JL 3rd, Johnson L, Schwartz MD, Kerner J, Leak C.

Cancer Control Program, Lombardi Cancer Center, Georgetown University Medical Center, 2233 Wisconsin Avenue NW, Washington, DC 20007, USA. taylorkl@georgetown.edu

OBJECTIVE: Studies have shown that African American men are at greater risk than other men for prostate cancer in terms of both incidence and mortality. At the same time, the utility of screening asymptomatic men for prostate cancer remains controversial. The combination of high incidence and high mortality with the uncertain benefits of screening poses a difficult problem for African American men. This study was part of an ongoing project that sought to develop and evaluate health education materials designed to help African American men make an informed decision about prostate cancer screening. The project represented a collaboration between the Most Worshipful Prince Hall Grand Lodge of the District of Columbia and the Lombardi Cancer Center of Georgetown University. METHODS: The authors conducted eight focus groups with 44 members of the Prince Hall Masons. The focus groups covered men’s understanding of prostate cancer screening and their preferences for methods of health education. RESULTS: Participants demonstrated a high level of awareness of the availability of prostate cancer screening, a low awareness of the screening controversy, and a desire for detailed epidemiologic information and information about the benefits and limitations of screening. The preferred forms of educational materials were video and print-based materials, which the research team has recently developed. CONCLUSIONS: These findings demonstrate the feasibility of developing an academic-community collaboration with the goal of improving a health-related problem in the African American community. A randomized trial is underway to evaluate the impact of the video and print education materials.

ABNF J. 2002 May-Jun;13(3):61-3.

A comparative study of prostate screening health beliefs and practices between African American and Caucasian men.

Lambert S, Fearing A, Bell D, Newton M.

McKendree College, Lebanon, Illinois, USA.

This descriptive comparative study investigated the prostate screening health beliefs and practices of men over the age of 45. A self-administered questionnaire was used prior to an informational session, which also included a question and answer period, as needed, and handout materials donated by the American Cancer Society on risk factors, screening tests and early detection of prostate cancer. The study results showed that there were no significant differences between African American and Caucasian men on age, self-reported health status and the utilization of a private physician for their health care. Both groups had similar history of blood relatives with cancer, and concern about development of illness. More Caucasian men had the digital rectal exam (DRE) done while African American males had the prostate-specific antigen (PSA) done more often; however, 26% of the entire sample indicated they had never had the screening test done. Group comparisons revealed a significant difference between the groups on the belief that faith contributes to health which was greater for the African Americans, while the Caucasian men had a greater belief that they were likely to develop prostate cancer. Results of this study indicate that there are still a significant number of men reporting never having had a PSA test done even though 75% knew that the test is recommended for early detection of prostate cancer. Continued efforts to educate and increase screening are still needed among both African American and Caucasian men.

ABNF J. 2002 May-Jun;13(3):56-60.

What we thought we knew: African American males’ perceptions of prostate cancer and screening methods.

Clarke-Tasker VA, Wade R.

Howard University College of Pharmacy, Nursing and Allied Health Sciences-Division of Nursing, 501 Bryant Street, SW, Washington, DC 20059, USA.

This study applied the Health Belief Model in determining African American male’s knowledge, attitudes and perceptions of prostate cancer and early detection methods. The ultimate value of the information assessed from this population was used to design specific theory-based, culturally relevant interventions which may decrease mortality in this high-risk population. Two focus groups were conducted with African-American men whose ages ranged from 38-80 years. After consenting to audio-taping, participants completed a survey questionnaire and viewed a culturally appropriate video on prostate cancer. Results indicate that, on average, the men believed in the efficacy of prostate cancer early detection methods. Study participants felt physicians did not adequately screen or suggest that they be screened for prostate cancer. Men between 40 and 50 years of age expressed concern about possible changes in their sex life if diagnosed with prostate cancer. Despite having limited knowledge of prostate cancer they considered a digital rectal examination to be embarrassing and uncomfortable. However, they were not opposed to having the procedure done.

Curr Urol Rep. 2000 May;1(1):57-64.

Screening for prostate cancer in African Americans.

Moul JW.

Center for Prostate Disease Research, 1530 East Jefferson Street, Rockville, MD 20852, USA. jmoul@cpdr.org

African American men are known to have a higher risk of developing prostate cancer. Historically, African American men have presented at a higher stage and had a worse outcome from the disease than non-African American men. There is an ongoing debate whether this disparity is due to biologic, environmental, or behavioral factors, or a combination of these factors. Furthermore, lack of access to care is implicated. Despite this debate, there is emerging data that African American men and their families are receptive to education and early detection. Encouraging data from the military, Veteran’s Administration, and private sector suggest that African American men can have a similar outcome to non-African American men if diagnosed early and treated effectively. Early detection efforts depend on prostate-specific antigen (PSA) testing. This article discusses various options for using the PSA test to more effectively screen African American men. In general, testing starting at age 40 is recommended using an upper limit of normal for PSA at 2.0 to 2.5 ng/mL for men between 40 and 49 years of age. In older men, maintaining this lower PSA threshold is reasonable to optimize curable cancer; however, published guidelines of 0 to 4.0, 0 to 4.5, and 0 to 5.5 ng/mL in African American men in their 50s, 60s, and 70s, respectively, are also recognized to balance the sensitivity and specificity of testing. Population-based prospective clinical trials of African American men are needed to further fine-tune the use of PSA in early detection, and to assess whether screening will improve the disease-specific mortality of prostate cancer in the population.

J Cult Divers. 2003 Summer;10(2):56-61.
Prostate cancer in black men of African-Caribbean descent.

Kleier JA.

Barry University, Miami Shores, FL, USA. jkleier@mail.barry.edu

Prostate cancer is a significant health problem for middle-aged and elderly men. In the United States (US), it is the most frequently diagnosed cancer and is the second leading cause of cancer death. While men of all racial and ethnic backgrounds are at risk, black men of African descent are at especially high risk. African-Caribbean men, particularly Jamaican men, have the highest rate of prostate cancer in the world. The term “African-American” has been used to describe all black people living in the US. Use of such broad categorization ignores the existence of subcultures within the black community. While members of the black race may share similar primary, genetic characteristics, skin color cannot be equated with attitudes, knowledge, and behaviors of particular cultural groups. Therefore, prostate cancer interventions developed for African-American men may not be effective for men of African-Caribbean descent

J Clin Oncol. 2002 Jun 15;20(12):2863-8.

Impact of race on prostate-specific antigen outcome after radical prostatectomy for clinically localized adenocarcinoma of the prostate.

Cross CK, Shultz D, Malkowicz SB, Huang WC, Whittington R, Tomaszewski JE, Renshaw AA, Richie JP, D’Amico AV.

Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA. ccross@partners.org

PURPOSE: To compare prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for prostate cancer in African-American and white men using previously established risk groups. PATIENTS AND METHODS: Between 1989 and 2000, 2,036 men (n = 162 African-American men, n = 1,874 white men) underwent RP for clinically localized prostate cancer. Using pretreatment PSA, Gleason score, clinical T stage, and percentage of positive biopsy specimens, patients were stratified into low- and high-risk groups. For each risk group, PSA outcome was estimated using the actuarial method of Kaplan and Meier. Comparisons of PSA outcome between African-American and white men were made using the log-rank test. RESULTS: The median age and PSA level for African-American and white men were 60 and 62 years old and 8.8 and 7.0 ng/mL, respectively. African-Americans had a statistically significant increase in PSA (P =.002), Gleason score (P =.003), clinical T stage (P =.004), and percentage of positive biopsy specimens (P =.04) at presentation. However, there was no statistical difference in the distribution of PSA, clinical T stage, or Gleason score between racial groups in the low- and high-risk groups. The 5-year estimate of PSA outcome was 87% in the low-risk group for all patients (P =.70) and 28% versus 32% in African-American and white patients in the high-risk group (P =.28), respectively. Longer follow-up is required to confirm if these results are maintained at 10 years. CONCLUSION: Even though African-American men presented at a younger age and with more advanced disease compared with white men with prostate cancer, PSA outcome after RP when controlled for known clinical predictive factors was not statistically different. This study supports earlier screening in African-American men.

Abstracts of Research from Sub Saharan African
West Afr J Med. 2003 Jun;22(2):173-6.

Orbital metastases of prostatic carcinoma in a tropical African population.

Shittu OB, Ogunbiyi JO.

Urology Division, Department of Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan.

We have reviewed the cases of orbital metastases from carcinoma of the prostate gland seen in the University College Hospital, Ibadan over an 11 year period, 1990-2000. During the period, seven cases of orbital metastases that presumably arose from carcinoma of the prostate were seen. Four of the patients died of progression of the primary disease over a variable period ranging between 2 weeks and 30 months of diagnosis and treatment, two were lost to follow up and one is alive 46 months after initial diagnosis of orbital metastases from carcinoma of the prostate and treatment.

Urology. 2003 May;61(5):987-92.

Clinical characteristics of prostate cancer in African Americans, American whites, and Senegalese men.

Gueye SM, Zeigler-Johnson CM, Friebel T, Spangler E, Jalloh M, MacBride S, Malkowicz SB, Rebbeck TR.

Hopital General de Grand Yoff and Universite Cheikh Anta Diop, Dakar, Senegal.

OBJECTIVES: To describe the clinical features of prostate cancer in Senegalese men and compare these features with those found in African-American and white American men. METHODS: We identified an unselected series of 121 patients with prostate cancer diagnosed at two hospitals in Dakar, Senegal between 1997 and 2002. Medical record abstractions were undertaken to evaluate the prostate tumor characteristics, patient age at diagnosis, prostate-specific antigen (PSA) levels, and reason for referral. In addition, these characteristics were compared with a sample of 455 U.S. white men and 60 African-American men with prostate cancer who were studied as part of a prostate cancer case-control study. RESULTS: Senegalese men had a significantly worse tumor stage than Americans (41.3% versus 18.8%, P <0.001), a significantly worse mean PSA level at diagnosis (mean PSA 72.7 ng/mL versus 9.0 ng/mL in Americans; P <0.001), and were diagnosed at a significantly later age than U.S. men (69 years versus 61 years, P <0.001). U.S. men were most likely to be diagnosed with prostate cancer after an elevated PSA test, and Senegalese men were most often diagnosed after presenting for prostate-related symptoms. CONCLUSIONS: These observations are not unexpected given the differences in the patterns of prostate cancer screening and health care in the United States compared with Senegal. However, our data provide descriptive information about the characteristics of prostate cancer diagnosed in Senegal and highlight differences in the characteristics and detection of these tumors across populations with very different healthcare systems.

Int J Urol. 2003 Jun;10(6):315-22.

Prevalence of elevated serum prostate-specific antigen in rural Nigeria.

Ukoli F, Osime U, Akereyeni F, Okunzuwa O, Kittles R, Adams-Campbell L.

Cancer Center and National Human Genome Center, Howard University, Washington DC, USA. fukoli@Howard.edu

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.

Prostate Cancer Prostatic Dis. 2003;6(1):34-8.

High-grade intra-epithelial neoplasia and prostate cancer in Dibombari, Cameroon.

Angwafo FF 3rd, Zaher A, Befidi-Mengue R, Wonkam A, Takougang I, Powell I, Murphy G; The National Health Survey Team for The National Epidemiology Board of Cameroon.

The National Health Survey Team For Chronic Diseases, National Epidemiology Board, Ministry of Public Health, Yaounde, Cameroon. fobuzshi@yahoo.com

High-grade prostatic intra-epithelial neoplasia (HGPIN) occurs a decade earlier in men of African descent in the US and Brazil, compared to white men. Prostate cancer incidence and mortality is worse in the African-American than in US white men. Sub-Saharan Africa was thought to be a low incidence area. This disparity has been attributed to lifestyle factors such as diet. We report the results of prostatic biopsies, from an ongoing national prostate cancer survey. One hundred and eleven men aged 40 y and over were recruited for medical interview (AUA symptom score), prostate specific antigen (PSA) assay and digital rectal examination (DRE). Between six and 10 cores of random digitally guided needle biopsies were performed on 24 subjects that had either suspicious prostates on digital rectal examination +/ or PSA > or =4 ng/ml. All lesions of the prostate were described on routine histopathology. The Gleason score and proportion of tissue involved with cancer, was determined. Eight men had benign prostatic hyperplasia (BPH), six had cancer, another six had low grade intra-epithelial neoplasia, two had HGPIN, there was one case of BPH and chronic prostatitis and one case of chronic prostatitis only. The cancer patients were aged 58-75 y (mean 66.93 y). Gleason scores ranged from 5 to 9, there was one score of 3. Cancer made up 20-80% tissue samples. HGPIN was found in two cases (mean age 58 y). Significant prostate cancer and the pre-cancerous lesion HGPIN exist in Dibombari, Cameroon. The purported low incidence of prostate cancer may reflect cultural and economic barriers to health care.

East Afr Med J. 2000 May;77(5):260-3.

Management and survival in advanced prostate cancer in Nairobi.

Magoha GA.

Department of Surgery, College of Health Sciences, University of Nairobi, P. O. Box 19676, Nairobi.

OBJECTIVE: To evaluate the management and survival of patients with advanced prostate cancer in this locality. DESIGN: A prospective case study. SETTING: Kenyatta National Referral Hospital and the Nairobi and Mater Hospitals. PATIENTS: Fifty nine patients with advanced cancer of prostate (extra prostatic locally advanced and metastatic cancer). RESULTS: Transperineal trucut needle biopsies of the prostate revealed 15 patients (25.42%) had poorly differentiated cancers with Gleasons scores greater than 7. Fifteen patients (25.42%) had moderately differentiated cancers with Gleason scores of 6; and twenty nine other patients (49.2%) had well differentiated cancers with Gleason scores of 4 and below. Surgical castration was effected on 15 patients four of whom also had 50 mg of oral bicalutamide (casodex) daily. Thirty six patients were treated with subcutaneous goserelin (zoladex) depot 3.6 mg every 28 days. Ten of these patients also had 50 mg oral casodex daily in addition to the zoladex. Three patients in this group also had external radiotherapy for severe bone pains. Only eight patients were treated with oral diethylstilboestrol 3 mg daily. All the 15 patients with undifferentiated cancers died within 12 months. Of the 22 patients surviving at 48 months irrespective of the method of treatment, 20 of them had well differentiated cancers with Gleasons scores of 4 or less. CONCLUSION: Survival in the undifferentiated and poorly differentiated prostrate cancer Gleasons grades 4 and 5 with a score of over 7 is poor irrespective of the mode of treatment as all the patients in this group were dead within 12 months of diagnosis. Twenty patients (90.90%) of the surviving patients at 48 months had well differentiated cancers Gleasons grades 1 and 2 with scores of 4 or less indicating better prognosis for these tumours which are known to be slow growing with a much longer tumour doubling time.

BJU Int. 2003 Jun;91(9):785-8.

Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa.

Heyns CF, Mathee S, Isaacs A, Kharwa A, De Beer PM, Pretorius MA.

Department of Urology and Family Medicine and Primary Health Care, University of Stellenbosch, Tygerberg Hospital, Western Cape, South Africa. cfh2@sun.ac.za

OBJECTIVES: To assess the feasibility of detecting early-stage prostate cancer in the primary healthcare setting, and to investigate whether there is a higher incidence of prostate cancer in Black African men. PATIENTS AND METHODS: The study was a collaboration with registrars in the authors’ institutions and primary healthcare centres serving mainly a Black African or mixed ancestry (Coloured) population in the semi-urban Cape Town metropolitan area of South Africa. Men aged 50-70 years attending the clinics were counselled about prostate cancer and invited to have a digital rectal examination (DRE), serum prostate-specific antigen (PSA) assay and transrectal ultrasonography-guided sextant prostate biopsy if the DRE was clinically suspicious of malignancy or the serum PSA was > or = 4.0 ng/mL. An American Urological Association Symptom Index (AUA-SI) was obtained, and urine analysed using dipsticks. RESULTS: From May 2000 to November 2001, 660 men were assessed (mean age 59.4 years, range 30-82); 60.6% were Black African, 37.3% mixed (Coloured), 1.8% White (Caucasian) and 0.2% Asian (Indian). The mean (range) AUA-SI was 5.98 (0-35) in the whole group; the DRE was recorded as clinically suspicious of malignancy in 3.2%. The mean PSA was 20.39 (0.04-10 000) ng/mL in the whole group, but when two outliers (1865 and 10 000 ng/mL) were disregarded, it was 2.4 ng/mL. In Black patients the mean PSA was 31.8 (0.04-10 000) ng/mL, and without the outliers, 2.1 ng/mL; in Coloured patients it was 2.94 (0.05-50) ng/mL. The PSA was > or = 4.0 ng/mL in 9.6% of the whole group, in 7.8% of Black and in 13% of Coloured patients. Prostate biopsies were taken in 21 patients (3.2% of the whole group and a third of those with a PSA of > or = 4.0 ng/mL); in Black patients, biopsies were taken in 1.5% and 19.4%, respectively, and in Coloured patients in 6.1% and 46.9%, respectively. The prostate biopsy showed cancer in 43% of the whole group, in a third of Black and in 47% of Coloured patients; prostate cancer was detected in 1.4%, 0.5% and 2.8%, respectively. CONCLUSIONS: That prostate biopsies were obtained in only 19% of Black and in only 47% of Coloured men with a serum PSA of > or = 4.0 ng/mL is of concern. This indicates that there is a significant problem in getting men with an elevated serum PSA level to undergo a prostate biopsy in the primary healthcare setting in South Africa.

Int J Urol. 2003 Jun;10(6):315-22.

Prevalence of elevated serum prostate-specific antigen in rural Nigeria.

Ukoli F, Osime U, Akereyeni F, Okunzuwa O, Kittles R, Adams-Campbell L.

Cancer Center and National Human Genome Center, Howard University, Washington DC, USA. fukoli@Howard.edu

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.

Niger Postgrad Med J. 2003 Mar;10(1):1-5.

Histopathological review of prostatic diseases in Kano, Nigeria.

Mohammed AZ, Alhassan SU, Edino ST, Ochicha O.

Department of Pathology, Bayero University, Kano, Nigeria.

Diseases of the prostate are common causes of morbidity in adult males and show wide geographical and ethnic variations in incidence and mortality worldwide. It is in the light of this that records of prostatic biopsies were reviewed in retrospect at the Aminu Kano Teaching Hospital, Kano and Murtala Mohammed Hospital Kano over a 4-year period in order to determine the histological pattern and age distribution of the various prostatic lesions. Three hundred and three prostatic lesions constituting 7.4% of all surgical biopsy specimens received were studied. Two hundred and thirty five (77.6%) of these were cases of BPH while prostatic cancer accounted for 22.4% of cases. The ratio of benign to malignant prostatic disease was 3:5:1. Chronic non-specific prostatitis, acute prostatitis, schistosomiasis and tuberculosis were present in 22.8%, 3.3%, 0.7% of the total number of cases respectively. The mean age of BPH patients was 63.7 years, and 88% of them had a glandulostromal histological pattern. Majority (64.2%) of the prostate cancers were well-differentiated adenocarcinoma and the mean age was 67.1 years. The findings confirm earlier observations that prostatic diseases are common causes of morbidity in our environment, and early diagnosis and treatment remain key measures in reducing mortality. The practice of 5-region biopsy is advocated to improve detection of clinical prostate cancer.

Cancer Epidemiol Biomarkers Prev. 2002 Aug;11(8):726-9.

High prevalence of screening-detected prostate cancer among Afro-Caribbeans: the Tobago Prostate Cancer Survey.

Bunker CH, Patrick AL, Konety BR, Dhir R, Brufsky AM, Vivas CA, Becich MJ, Trump DL, Kuller LH.

Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. bunkerc+@pitt.edu

Risk for prostate cancer is high among African Americans.We hypothesized that risk for prostate cancer is also high in other populations of African descent. Our objective was to determine the screening-detected prevalence of prostate cancer in the predominantly Afro-Caribbean population on the island of Tobago. Male residents, ages 40-79 years, were invited to participate in a population-based screening for prostate cancer using serum prostate-specific antigen (PSA) and digital rectal exam (DRE). Men with elevated PSA (>or=4 ng/ml) or abnormal DRE were offered an ultrasound-guided sextant biopsy of the prostate gland. Men (2484), ages 40-79 years, underwent prostate cancer screening between September 1997 and June 2001. Mean age was 55.9, SD was 10.6 years, and median was 54 years. Mean serum PSA was 14.8 ng/ml, SD was 376 [excluding 4 values >or= 2 SD above the mean (1,112, 1,317, 1,818, and 18,330 ng/ml) mean PSA was 5.5 ng/ml and SD was 29.6], and median PSA was 1.2 ng/ml. Elevated PSA and/or abnormal DRE were observed in 31% (759 of 2484) overall, and in age groups 40-49 (87 of 843, 10%), 50-59 (201 of 729, 28%), 60-69 (262 of 584, 45%), and 70-79 (209 of 328, 64%). Of 681 men biopsied, 259 (38%, or 10% of the 2484 screened) were diagnosed with prostate cancer. Age-specific rates of screening detected prostate cancer were: 1%, ages 40-79 years; 7%, ages 50-59 years; 18%, ages 60-69 years; and 28%, ages 70-79 years. These screening results indicate a very high screening-detected prevalence of prostate cancer in this population of West African descent. These data support the hypothesis that populations of African descent share genetic and/or lifestyle factors that contribute to their elevated risk for prostate cancer.

J Natl Med Assoc. 2002 Jul;94(7):619-27.

The changing pattern of prostate cancer in Nigerians: current status in the southeastern states.

Ekwere PD, Egbe SN.

College of Medical Sciences, University of Calabar, Nigeria. pekwere@hotmail.com

This was a ten-year, hospital-based retrospective study for the incidence and clinical pattern of prostate cancer in southeastern Nigeria. Clinical information extracted from the files included the TNM stage, histo-pathological grading, level of prostatic acid phosphatase (PAP), mode of presentation and clinical and biochemical response to intravenous and oral diethylstilboestrol diphosphate (Honvan)/ orchidectomy. There were 145 patients, mean age 66.6 + 9.8 years, giving an incidence of 61.3 per 10(5), with 54% under 70 years. Most patients (81.4%) presented late, with 62% metastatic. Over 98% were adenocarcinomas, 77% of which were moderate to well-differentiated cancers. PAP was elevated in 109 patients (75%), (representing 92% of all advanced tumours), and normal in 36 (25%). Forty-two percent of poorly differentiated cancers had normal levels of PAP. Most patients presented with urinary retention (56%), prostatism (44%), anaemia (41%), recurrent UTI (35%), bone pains (20%), haematuria (18%), backache (16%) and paraplegia (6%). Nearly 79% responded to treatment with lowered PAP levels and improved quality of life, within a mean of 26.3+/-13.8 months (range 5-78); objective 81 (58%), subjective 32 (23%), no response 27 (19%). Among paraplegics, 78% had full, and 22% had partial motor recovery. Patients with poorly differentiated cancers had only a 33% two-year survival rate. This study confirmed an upward, though moderate trend in the incidence of prostate cancer in Nigeria. The use of PAP instead of PSA as the tumor marker, a local diet with high fish content but lower animal fat, and poor hospital access may account for the lower incidence in the southeast. Poor health education may account for the high rate of late presentations

Eur J Cancer Prev. 2002 Feb;11(1):63-5.

Low serum prostate-specific antigen levels in elderly rural African men at very low risk of prostate cancer.

Wadee AA, Kuschke R, Botha Y, Jamieson GA, Walker AR, Kakembo AS, Vorster HH.

Department of Immunology, School of Pathology, University of the Witwatersrand, and the South African Institute for Medical Research, Johannesburg, South Africa.

Afr J Med Med Sci. 2000 Jun;29(2):97-100.

Prostate specific antigen in the Nigerian African.

Abbiyesuku FM, Shittu OB, Oduwole OO, Osotimehin BO.

Department of Chemical Pathology, University College Hospital, Ibadan, Ibadan, Nigeria.

The biological characteristics of prostate-specific antigen were studied in the Nigerian African. Two hundred and fourteen persons were selected for the study. The group was made up of 59 apparently healthy men (age range 22-76 years), 58 men (age range 40-91 years) who had biopsy proven diagnosis of cancer of the prostate gland, 81 men (age range 46-87 years) who had biopsy proven benign prostatic hypertrophy (BPH) and 16 women (age range 23-47 years). Their median ages were 53 years, 66 years, 66 years and 27 years, respectively. The median PSA value among the control population was 0.7 ug/L (range 0.1-4.3 ug/L) and 98.3% of them had PSA of less than 4 ug/L. No person below 50 years of age had PSA value greater than 2 ug/L. There was a significant correlation between age and serum PSA value over the entire age range (r = 0.523; P = 0.001). In the female study group, 4(25%) had detectable values the cause of which could not be determined. The median PSA value among the BPH patients was 8.5 ug/L (range 0.2-350 ug/L). In this group 37% of them had values below 4 ug/L and 54.3% of them had values less than 10 ug/L. Among the patients who had cancer of the prostate gland the median PSA value was 92.6 ug/L and the mode was greater than 350 ug/L (32% of the patients); 10% and 20% of them had values below 4 ug/L and 10 ug/L respectively. It is concluded that the trend is the same as in the studies and there is the need for prostate gland volume studies and evaluation of women who have detectable PSA values.

Cancer. 2000 Aug 1;89(3):653-63.

Cancer incidence in Abidjan, Ivory Coast: first results from the cancer registry, 1995-1997.

Echimane AK, Ahnoux AA, Adoubi I, Hien S, M’Bra K, D’Horpock A, Diomande M, Anongba D, Mensah-Adoh I, Parkin DM.

Services de Cancerologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast.

BACKGROUND: There are few data concerning cancer incidence rates in contemporary West Africa. The first data from the cancer registry of Abidjan, the capital of Ivory Coast, for the period 1995-1997 are reported in the current study. METHODS: The cancer registry attempts to record data on all new cases of cancer diagnosed in the city of Abidjan, including cases without histologic confirmation of diagnosis. RESULTS: Two thousand eight hundred fifteen new cancer cases were registered in 3 years, corresponding to age-standardized (world population) incidence rates of 83.7 per 100,000 in men and 98. 6 per 100,000 in women. As reported elsewhere in West Africa, the principal cancers in men were liver cancer (15%) and prostate cancer (15.8%), with modest rates of non-Hodgkin lymphoma (10.5%) and gastric cancer (4.5%). In women, breast cancer was the most frequent tumor (25.7%), followed by cervical cancer (24.0%) and non-Hodgkin lymphoma (7.3%). In contrast to other registry data from West Africa, Kaposi sarcoma occurs with moderate frequency (7.7% of cases reported in men and 2.1% in women). In the pediatric age group, relatively high incidence rates were found for Burkitt lymphoma. CONCLUSIONS: Although there most likely is some underascertainment of cases, so that the actual incidence rates may be underestimated, the cancer profile should be a fair reflection of the true situation. In addition to tumors that are well known to be common in sub-Saharan Africa, such as cancers of the liver and cervix, this urban population shows some features of “Westernization” of cancer patterns, in particular the relatively high rates of breast cancer and prostate cancer. The effects of the acquired immunodeficiency syndrome epidemic are reflected in the moderate rates of Kaposi sarcoma reported.

BJU Int. 2000 Jun;85(9):1074-7.

Benign prostatic hyperplasia and prostate carcinoma in native Africans.

Dawam D, Rafindadi AH, Kalayi GD.

Departments of Surgery and Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

OBJECTIVE: To study the factors associated with morbidity and mortality in benign prostatic hyperplasia (BPH) and carcinoma of the prostate in native Africans. PATIENTS AND METHODS: A prospective study was conducted from 1993 to 1998 at the Ahmadu Bello University Teaching Hospitals, Zaria, Nigeria. During this 5-year period 686 patients were investigated and treated for symptoms and signs of prostatism. They were followed up for a mean (range) of 19.5 (1-60) months. RESULTS: BPH was found in 588 and clinical carcinoma in 98 patients. Adequate results, including a histological diagnosis, were available for 640 patients; there were 545 patients with BPH and 95 patients with histologically diagnosed prostate cancer. Treatment consisted of open prostatectomy for BPH, and subcapsular orchidectomy and/or open bladder-neck wedge resection for patients with prostate cancer and bladder neck obstruction. Within 6 months of surgery, four of 545 (0.7%) patients with BPH and 25 of 95 (26. 3%) with prostate cancer had died. Two-thirds of the patients with cancer presented with paraparesis or paraplegia. CONCLUSIONS: BPH and prostate cancer cause significant morbidity and mortality in African men. There is a need for health education about the early recognition of symptoms. Provision of facilities for transurethral prostatectomy would minimize the complications of surgery and ensure better use of the meagre resources available for health care.

J Natl Med Assoc. 1999 Mar;91(3):159-64.

Increased incidence of prostate cancer in Nigerians.

Ogunbiyi JO, Shittu OB.

Department of Pathology, University College Hospital, Ibadan, Nigeria.

An increased incidence of prostate cancer among African-American men (now the second most common cause of cancer death) has been attributed mainly to the introduction of screening techniques, which have enabled earlier diagnosis of patients. This study reviewed male cancer patients recorded in a Nigerian cancer registry to assess the current trends in prostate cancer in Nigeria. For comparison, data were broken into two groups: 1980-1988 and 1989-1996. Only the top 10 cancers occurring in both periods were considered initially in this report. For emphasis, an analysis of adult male cancers was done per decade since 1960. Results show that prostate cancer has become the number one cancer in Nigerian men and constitutes 11% of all male cancers. The median age of patients was 67.5 years (variance 5.6), and the mean age was 71.4 years (variance 14.3). These results indicate that despite the absence of screening programs in Nigeria, the number of prostate cancer cases has increased. The known risk factors probably contribute to a varying degree among Nigerians, who are generally of average build or in the low-normal range for body mass index. Moreover, the role of genetics cannot be underplayed. Given its biological characteristics, more cases of prostate cancer probably would be recorded among this population if screening were undertaken.

Tunis Med. 1998 Feb;76(2):1061-4.

[Incidence and epidemiology of prostatic cancer in the Urology Department at CHU-Tokoin (Lome-Togo)] [Article in French]

Anoukoum T, Attipou KK, Napo-Kaoura AG, Ayite A, Safwat Y, James K.

Service d’Urologie Chu-Tokion.

J Natl Med Assoc. 1998 Nov;90(11 Suppl):S720-3.

Migration and prostate cancer: an international perspective.

Angwafo FF.

Department of Urology, University of Yaounde, Cameroon.

There are intra- and interracial differences in prostate cancer incidence and mortality rates worldwide. The environment and migration patterns seem to influence the disparities in cancer statistics. The lowest incidence rate is recorded in Chinese, followed by other Asians, South Americans, southern Europeans, and northern Europeans, in ascending order. However, people of African descent have the highest incidence so far. Until recently, African Americans in Alameda County (California) in the United States had the highest reported incidence (160/1000,000). An incidence of 314/100,000 recently was reported in African Caribbeans from Jamaica. These high rates contrast with the low incidence rates reported in continental (Sub-Saharan) Africa. Angwafo et al have reported higher age-adjusted incidence rates in Yaounde, Cameroon (93.8/100,000). They highlighted the importance of diagnostic methodology, availability of and access to diagnostic techniques and trained manpower, and adjustments for the age distribution of populations when comparing incidence rates between regions. The great disparity in cancer statistics over large geographic areas and races has oriented studies toward genes and gene products susceptible to environmental risk factors such as diet, ultraviolet rays, and cadmium, which may be associated with or causative of prostate cancer. Randomized studies on suspected risk factors and promoters of prostate cancer need to be conducted worldwide. However, caution is in order when inferences are made comparing populations with access to health care to those without.

J Urol. 1997 Apr;157(4):1340-3.

Prostate cancer in Nigerians: facts and nonfacts.

Osegbe DN.

Department of Surgery, College of Medicine and Lagos University Teaching Hospital, Nigeria.

PURPOSE: We established the actual incidence of prostate cancer in Nigeria, the largest concentration of indigenous black patients in the world, to ascertain whether the global ranking for Nigeria as a low risk for prostate cancer is accurate. MATERIALS AND METHODS: We prospectively studied Nigerian men 45 years old or older with prostatic symptoms. Patients histologically positive for prostate cancer were analyzed for clinical features, tumor characteristics and survival. The hospital incidence, national prostate cancer risk, pool and death rate were calculated from the hospital admissions data and national population statistics. RESULTS: Mean age of patients with prostate cancer plus or minus standard deviation was 68.3 +/- 9.4 years. The hospital incidence was 127/100,000 cases. The national prostate cancer risk was 2% of patients, the pool was 110,000 and the death rate was 20,000 annually. The predominant clinical findings were those of advanced disease. Approximately 64% of the patients died within 2 years. CONCLUSIONS: Prostate cancer incidence and the magnitude of the risk in our population may have been grossly underestimated. The clinical prostate cancer rate in Nigerians may be as great as that noted in black men in the United States, which may suggest a common enhancing genetic predisposition.

West Afr J Med. 1996 Jan-Mar;15(1):56-60.

Prostatic tumours in Benin City, Nigeria.

Akang EE, Aligbe JU, Olisa EG.

Department of Pathology, University College Hospital, Ibadan, Nigeria.

Prostatic tumours accounted for 10.2% of all surgical specimens from male patients received in the Department of Anatomic Pathology of the University of Benin Teaching Hospital, Nigeria between 1973 and 1990. Nodular prostatic hyperplasia accounted for 83% of the cases and the peak age incidence was in the sixth decade of life. Prostatic cancer occurred in the remaining 17% of the cases and the peak age incidence for occurrence was in the seventh decade of life. The commonest malignant neoplasms encountered were adenocarcinomas, out of which 64% were-well 27% moderately-and 9% poorly-differentiated. Sixty-one adenocarcinomas were classified as cases of incidental carcinoma of the prostate. Rare histological variants of prostatic cancer encountered in the present study included a case each of mucinous carcinoma, transitional cell carcinoma and rhabdomyosarcoma.

East Afr Med J. 1995 May;72(5):283-7.

Epidemiological and clinical aspects of incidental carcinoma of the prostate in Africans: experience at the Lagos University Teaching Hospital, Lagos and the Kenyatta National Hospital, Nairobi.

Magoha GA.

Department of Surgery, College of Health Sciences, University of Nairobi.

Twenty patients in Lagos and 24 patients in Nairobi with incidental carcinoma of the prostate in resected glands for benign hyperplasia were studied at the Lagos University Teaching Hospital (1978-1982) and at Kenyatta National Hospital (1988-1992), respectively. The age range for the Lagos group was 45-78 years with a mean age of 61 years and a peak incidence in the seventh decade (60-69 year age group) compared to the Nairobi group with age range of 50-89 years with a mean age of 66 years and a peak incidence in the eighth decade (70-79 year age group). Both groups had predominantly well differentiated low grade stage TIA (AI) incidental carcinoma of the prostate, being 80% in the Lagos group and 79.2% in the Nairobi group. High grade undifferentiated stage TIB (A2) incidental carcinoma of the prostate was present in 20% of the Lagos group and 20.8% of the Nairobi group. In both groups, the majority of patients (80%) in the Lagos group and (79.2%) in the Nairobi group presented late with similar symptoms of prostatic obstruction.

1: Bull Cancer. 1995;82(5):384-5.

[Prostatic tumors (adenoma, adenocarcinoma) and obesity in Cameroon] [Article in French]

Mbakop A, Angwafo FF, Tsingain K.

Service d’anatomie pathologique, hopital general de reference, Yaounde, Cameroun.

The aim of this study was to look for an association between obesity and prostatic tumors in general in Cameroon. During a sixteen month period (1 September 1991 to 31 December 1992), we recruited 50 symptomatic patients with histologically confirmed prostatic tumors who were matched with a control of the same age. Of these patients, 36 had adenomas, 12 had carcinomas, two had both tumors. Patients’ age ranged from 49 to 91 years. The difference in body weight and height between the patients and the controls was not significant. According to the Lorentz formula, there were as many obese patients as controls. Obesity was five times more frequent in the patients than the controls following the body mass index, but this difference was not significant. We conclude that in our area, there might be an association between obesity and prostatic tumors in general but our study is too small to reach a conclusion.

Cancer Surv. 1995;23:281-6.
The geography of prostate cancer and its treatment in Africa.

Kehinde EO.

Department of Urology, University of Leicester, Leicester General Hospital.

Cancer of the prostate is perhaps the commonest urological malignancy affecting Africans. The incidence between different countries varies and mirrors very closely the socioeconomic status of the countries and the life expectancy. The disease has an early peak incidence at ages 55-64 years, compared to 65-74 years for whites. This is primarily due to the low life expectancy in Africans. Late presentation is a common feature in Africans. Stilboestrol is widely used in treating disseminated cancer of the prostate not only because it is cheap and effective, but also because the cardiovascular side effects of stilboestrol seem not to be serious in Africans compared to whites. Further study of cancer of the prostate gland in indigenous Africans should provide vital data on the epidemiology and aetiology of this important cancer and may shed light on why the clinical aggressiveness of the disease varies from one part of the world to another.

Bull Cancer Radiother. 1994;81(2):155-9.

Is cancer of the prostate rare in tropical (black) Africa? Case series from the Centre Hospitalier et Universitaire and the Hospital General de Yaounde from 1986 to 1990.

Angwafo FF, Yomi J, Mbakop A.

Department of General Surgery and Subspecialties, Faculty of Medicine and Biological Sciences, University of Yaounde, Cameroon.

The objective of this study was to determine the crude incidence of cancer of the prostate in a hospital-based population. Patients presenting at urological clinics were studied using a standard proforma. The settings included the urological outpatient clinics and hospital wards of the University Hospital Center (CHU) and the Yaounde General Hospital (HGY)–Institutions of the University of Yaounde I, Faculty of medicine and biological sciences, Centre Pasteur de Yaounde. Included were 447 new male patients over age 40, observed over a five-year period. All patients underwent standard clinical evaluation, laboratory and radiological studies. Patients with abnormal prostates, enlarged lymph nodes, metastatic bony lesions had tissue removed for histology. Seventy-two patients with abnormal prostates had them biopsied. Five had excisional biopsy of enlarged supraclavicular lymph nodes in addition to abnormal prostates. Six patients with bony lesions, elevated prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) did not have tissue diagnosis. Thirty-three patients were treated with orchidectomy and fefosterol (ST-52) and 12 with ST-52 only. Seventy-eight out of 447 patients had abnormal clinical findings. 39 of these had a tissue diagnosis of adenocarcinoma of the prostate. Six others with probable cancer of the prostate did not have a tissue diagnosis. All but one patient with stage C disease had stage D disease. The calculated age-adjusted incidence of cancer of the prostate is 93.8 cases per 100,000. Cancer of the prostate is common in the blacks of Cameroon and its incidence is increasing annually.

: Int J Cancer. 1993 Apr 22;54(1):26-36.

Cancer in Kampala, Uganda, in 1989-91: changes in incidence in the era of AIDS.

Wabinga HR, Parkin DM, Wabwire-Mangen F, Mugerwa JW.

Department of Pathology, Makerere Medical School, Kampala, Uganda.

Re-establishment of the cancer registry in Kyadondo County, Uganda, has allowed estimation of incidence rates for the period September 1989 to December 1991. The results are compared with earlier data from the same area, and from other African cancer registries. The most striking feature is the emergence of Kaposi’s sarcoma as the leading cancer in males (almost half of all registered cases) and the second most frequent (17.9%) in females. This parallels the evolution of the epidemic of AIDS. There were also marked increases in the incidence of both oesophageal and prostatic carcinoma, while the incidence of cancer of the penis and the urinary bladder declined, possibly as a result of improved standards of hygiene. In females, the incidence of cancer of the cervix has more than doubled since the 1950s, and is now among the highest recorded in the African continent.

PIP: The Kampala Cancer Registry (KCR), in Kyadondo County, Uganda, was established in 1951. During 1972-87, KCR activity was reduced because of the Ugandan political situation. Reactivation of the KCR has provided data on incidence in Kyadondo County residents from September 1989 to December 1991. Kyadondo County had just over 1 million residents (living there at least 1 year) in 1991. Data sources were the records of the Department of Histopathology, which receives KCR registration information along with specimens, and hospital records verified by a cancer registrar from the 4 major county hospitals. (Death certificates are not available at present in Uganda). These data were compared with those reported in 1954-60 and 1968-70 to determine changes in cancer incidence in an era marked by changing lifestyles and the emerging AIDS epidemic. 558 males and 675 females were registered in the 28-month period. Data were tabulated separately for males and females, showing number of cases/site and average annual age-specific incidence rates. Age-standardized incidence rates were compared for 1989-91, 1954-68, 4 other African population-based series, and White and Black US population rates. The most frequent 1981-91 cancers for men were Kaposi’s sarcoma, 48.6% esophagus, 6.9%; nonHodgkin’s lymphoma (NHL), 6.2%; prostate, 5.5%; and liver, 4.9%. In women, the most frequent cancers were cervical, 32.1% in the highest record in Africa; Kaposi’s sarcoma, 17.9%; and breast cancer, 11.4%. A comparison to earlier KCR data revealed that incidence of Kaposi’s sarcoma has increased from 2.6 to 30.1/100,000 in men and from 0 to 11/100,000 in women. This finding is clearly related to the AIDS epidemic. However, the rate of NHL, which is an increased risk for US AIDS patients, has shown little change. However, the incidence of NHL (specifically Burkitt’s) in KCR children 0-14 years old is relatively high (19/1/million in boys and 12.1/million in girls), and the AIDS epidemic may be responsible, although much remains to be discovered about AIDS-related NHL, particularly Burkitt’s. Incidence increases were found in men for esophageal and prostate cancer, whereas cases of cancer of the penis and bladder declined. In women, the incidence of cervical cancer doubled since the 1950s. Breast cancer, while the third most common, shows the typical low, rate of a low-birth population, although the rate has doubled since 1954-60

Br J Cancer. 1992 Mar;65(3):438-41.

Case-control study of prostate cancer in black patients in Soweto, South Africa.

Walker AR, Walker BF, Tsotetsi NG, Sebitso C, Siwedi D, Walker AJ.

Department of Tropical Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa

Cent Afr J Med. 1992 Mar;38(3):91-4.

Zimbabwe National Cancer Registry: summary data 1986-1989. National Cancer Registry Advisory Committee.

Bassett MT, Levy LM, Chetsanga C, Chokunonga E.

Department of Community Medicine, Avondale, Harare.

The Zimbabwe National Cancer Registry began operation in 1986. Between 1986-1989, a total of 8 276 cases were identified. Among men of African descent, oesophageal (11.2 pc) and liver cancer (11.0 pc) were most common. Cervical cancer was by far the most common among women of African descent (34.5 pc). Among both males and females of non-African descent, skin cancers (other than melanoma) accounted for one-third of cancers followed by prostate cancer (7.7 pc) in males and breast cancer (18.5 pc) in females. These findings are comparable to earlier reports of the epidemiology of cancer in Zimbabwe.

Br J Urol. 1991 Jan;67(1):37-9.

Pattern of urological malignancy in Zambia. A hospital-based histopathological study.

Elem B, Patil PS.

Department of Surgery, University of Zambia School of Medicine, Lusaka.

The pattern of urological malignancy among the indigenous population of Zambia (determined on the basis of histopathological reports from a major national hospital during an 8-year period) is presented. A total of 6514 malignancies were observed, of which 784 (12%) were of urological origin. Bladder carcinoma, predominantly squamous type, was the commonest urological tumour (51%), followed by carcinoma of the prostate (26%), carcinoma of the penis (18%), renal tumours (4.3%) and testicular malignancy (0.7%). In nearly 32% of the bladder tumours, bilharzial ova were demonstrated histopathologically. Nephroblastoma accounted for 70% of the renal tumours and from a total of 7 cases of testicular tumours 5 were embryonal carcinoma and 2 seminoma. A brief reference is made to the pattern and aetiology of urological malignancies in some neighbouring countries.

East Afr Med J. 1989 Jun;66(6):400-3.

Subcapsular orchidectomy in the management of prostatic carcinoma in Nigerians.

Magoha GA.

Thirty patients with advanced prostatic carcinoma were treated by subcapsular orchidectomy at the urology unit of the Lagos University Teaching Hospital. Post orchidectomy plasma testosterone levels measured at 3 and 6 months were low in all patients with a mean of 44 ng/100 mls +/- S.D. 21 compared to levels in the control group of 10 untreated prostatic cancer patients with a mean of 526 ng/100 mls +/- S.D. 109; the difference being highly significant (P greater than 0.001). Subcapsular orchidectomy was effective in the treatment of 28(93.3%) of the 30 prostatic cancer patients as assessed by diminution in the size of primary tumours per rectum, improvement of urinary symptoms and reduction of skeletal metastases radiologically. None of the patients showed the undesirable side effects of prolonged oestrogen therapy and psychological trauma of total orchidectomy. These results indicate that subcapsular orchidectomy is effective in the treatment of advanced prostatic cancer in this locality.

Cancer. 1989 Apr 1;63(7):1388-92.

Zinc and cadmium concentrations in indigenous blacks with normal, hypertrophic, and malignant prostate.

Ogunlewe JO, Osegbe DN.

Department of Surgery, Lagos University Teaching Hospital, Nigeria.

In order to determine the role of cadmium and zinc in the very low incidence (10/100,000) of cancer of the prostate, in African blacks which contrasts with the very high incidence (100/100,000) in American blacks, the authors measured the serum and prostatic concentrations of these trace metals in healthy Nigerian men and those with benign prostatic hypertrophy (BPH) and prostatic cancer using atomic absorption spectrophotometric study. The mean plasma zinc concentration of healthy men was 14.9 mumol/l +/- 0.5 SEM, whereas those with BPH and malignant glands were 16.5 mumol/l +/- 0.6 SEM and 11 mumol/l +/- 0.7 SEM, respectively. The mean serum cadmium concentrations were 15.2 mumol/l +/- 0.6 SEM, 15.5 mumol/l +/- 0.7 SEM, and 24.2 +/- 0.9 SEM for normal, BPH, and cancer subjects, respectively. The mean prostatic tissue zinc concentration in normal gland was 12.1 mumol/g +/- 0.8 SEM, BPH 17.9 mumol/g +/- 0.6 SEM, and cancer gland 2.9 mumol/g +/- 0.4 SEM. The mean prostatic tissue cadmium concentration for normal BPH and malignant glands were 3.8 mumol/g +/- 0.6 SEM, 14.6 mumol/g +/- 0.37 SEM. The serum and prostatic tissue values of these trace metals in our controls, BPH, and cancer subjects compare with those from populations with higher prostatic cancer rates. This suggests that these metals do not primarily play any significant role in the reported low incidence rate of prostatic cancer in our community. Furthermore, in control subjects and those with BPH, cadmium/zinc ratio, whether evaluated for serum or prostatic tissue was one or less. In patients with cancer, however, this ratio was always greater than one. The possible clinical use of this ratio to diagnose cancer of the prostate gland and to follow-up such patients needs to be further evaluated through more studies

Int Urol Nephrol. 1989;21(5):449-54.

Patterns and management of urinary tract cancers among Nigerian Igbos.

Attah C.

College of Medicine, University of Nigeria Teaching Hospital, Enugu.

Eighty-three cases of histologically diagnosed urinary tract cancers treated within 5 years at the Urology Unit of the University of Nigeria Teaching Hospital, Enugu, among Nigerian Igbos have been reviewed. Whereas cancer of the prostatic gland is the commonest, urethral and ureteric cancers are the rarest. Treatment modality except for cancer of the prostate is largely surgical.

Z Urol Nephrol. 1987 Nov;80(11):625-8.

[Incidence and significance of bilharziasis in the Republic of Mozambique] [Article in German]

Ebert W.

Pathologisches Institut, Friedrich-Schiller-Universitat Jena.

The bilharziosis, primarily a parasitosis of tropical countries sometimes plays a role also in the consulting hour of the physician in the GDR, especially of the urologist, therefore, it should be differential-diagnostically known to the physicians. The author reports on his activity at the Institute of Pathology of Maputo University, People’s Republic Mocambique, and informs about bilharziosis on the basis of bioptic investigations especially of the urogenital tract. The high coincidence of the bilharziosis infection of the urinary bladder with the development of a in most cases planely growing squamous cell carcinoma. The frequency of the carcinoma of the urinary bladder in the People’s Republic Mocambique is the greatest of the world. Pro year for 100,000 Africans in men there are 24 carcinomas, in women 19 ones. It is the second in frequency malignant tumour in the male following the primary liver carcinoma and the third in frequency of the female after the liver carcinoma and the uterine cervix carcinoma. The bilharziosis infection is also responsible for the great number of cervix carcinomas and tubal pregnancies.

Int Urol Nephrol. 1987;19(3):279-85.

Ultrasonography of the prostate: a preliminary report from Nigeria.

Iko BO, Monu JU, Mangete ED, Nduka NR.

Department of Radiology, University of Port Harcourt Hospital, Nigeria.

Suprapubic transabdominal prostatic sonography was performed at two Nigerian centers over the past year. All abnormal glands were found enlarged. Capsular, periprostatic and extra-organ features helped to segregate carcinomas from benign diseases. Gland shape and internal texture were less useful criteria. Prostatic sonography has great promise in developing and fragile economies, where other efficacious and contemporary imaging modalities are unaffordable.

S Afr Med J. 1986 Jan 4;69(1):44-7.

Prostate cancer–some aspects of epidemiology, risk factors, treatment and survival.

Walker AR.

In Western populations prostate cancer was probably rare in the past, yet in many populations the mortality rate has risen 3-5-fold since 1910. The disease now affects 1 man in 20. While the incidence in Third World populations living traditionally remains low, it increases with urbanization and prosperity, as in South African blacks. While the disease is age-related, more common in married than in single men and family-orientated, knowledge of specific aetiological factors is meagre. Abnormal hormonal status may well be involved, and possibly diet (Western v. Third World diet). There is a strong hormonal influence on tumour development. Treatment, according to the stage of the disease, includes prostatectomy, hormonal manipulation, external irradiation and chemotherapy; 70% of patients are surgically incurable at the time of presentation. Survival is greatly affected by the stage at diagnosis; the percentage surviving 5 years is 3 times higher for patients at stage A than for those at stage D. Little can be done to avoid prostate cancer because of inadequate understanding of risk factors. Annual rectal examination between 40 and 65 years is urged, since surgical cure is possible when metastases are absent.

Acta Urol Belg. 1986;54(1):37-48.

Urogenital tumors in Kinshasa. An overview of 25 years experience.

Tshipeta N, Lufuma L, Zangani V, Mwembo M, Likinda B.

J Urol. 1986 Jan;135(1):58-9.

Survival of black men with prostatic cancer in Soweto, Johannesburg, South Africa.

Walker AR, Walker BF, Isaacson C, Doodha MI, Segal I.

While prostatic cancer has a low frequency in rural African black men living traditionally, the disease occurs more often and is increasing in black men in the cities. Between 1982 and 1984, 101 patients with prostatic cancer were detected in Soweto, Johannesburg. Of these patients 90 had clinical stage D disease and metastasis was common. The 50 per cent mortality period of 1.6 years, while similar to that reported in some series of white patients, is considerably shorter than that noted in several others series.

East Afr Med J. 1985 May;62(5):332-7.

Prostate-specific acid phosphatase in Nigerian patients with prostate carcinoma.

Bolarin DM, Badejo OA.

Nord Med. 1985;100(12):328-9.

[Results of open prostatectomy at a Tanzanian hospital] [Article in Swedish]

S Afr Med J. 1984 May 19;65(20):795-804.

Geographical distribution of certain cancers in South Africa, 1968-1972.

McGlashan ND, Harington JS, Bradshaw E.

The geographical distributions of six major causes of cancer mortality in South Africa have been analysed for three population groups: White, Coloured and Asian. Because of the lack of comparable data, the majority Black population is not included. Geographical patterns are compared and discussed in the light of findings from other countries. In several cases the potential for aetiological follow-up is demonstrated.

Cancer Res. 1982 Sep;42(9):3864-9.

Effect of diet on plasma and urinary hormones in South African black men with prostatic cancer.

Hill P, Wynder EL, Garbaczewski L, Walker AR.

Epidemiological evidence suggests that the incidence and death rate from prostatic cancer, an endocrine-associated disease, are related to environmental factors including diet. In this study, a comparison of serum and urinary levels of steroid hormones was carried out in healthy elderly rural vegetarian South African black men, a low-risk population, and a comparable group of men with prostatic cancer. In these prostatic cancer patients, plasma androgen levels decreased, while estrogen levels increased. Concomitantly, the androsterone:etiocholanolone ratio increased, and a greater proportion of estrogens was excreted as estriol. When transferred to a Western diet, plasma androgens showed a further decrease and a greater increase in estrone in prostatic cancer patients. In prostatic cancer patients, the total urinary androgen and estrogen levels were unaltered. However, in elderly healthy men, the Western diet decreased the excretion of estrogens and androgens. Thus, a Western diet supplemented the decrease in plasma androgens initially present in these patients. Evidence suggests that the decrease in plasma androgens increases the estrogen: androgen ratio, which may lead to hyperplasia of the prostatic ductal epithelia, a change enhanced by a Western diet. Changes in urinary steroid hormone levels in South African black patients comparable to those reported in white prostatic cancer patients indicate that hormonal changes must be related to several environmental factors, apart from diet. A simultaneous study of the steroid hormone composition of blood and prostatic fluid in this low-risk population is suggested.

Cancer Res. 1982 May;42(5):2074-80.

Response to luteinizing releasing hormone, thyrotrophic releasing hormone, and human chorionic gonadotropin administration in healthy men at different risks for prostatic cancer and in prostatic cancer patients.

Hill P, Wynder EL, Garbaczewski L, Garnes H, Walker AR.

A comparative study of the pituitary and testicular response to luteinizing releasing hormone (LHRH), thyrotrophic releasing hormone (TRH), and human chorionic gonadotrophin (HCG) administration was carried out in (a) low-risk young South African black men and high-risk North American black men for prostatic cancer and (b) healthy elderly South African men and South African black men with prostatic cancer. A comparable HCG response occurred in young South African and North American black men, while a greater release of prolactin, but a lesser release of luteinizing hormone in response to LHRH:TRH occurred in South African black men. The response to HCG was comparable in elderly and young South African black men, although the prolactin release in response to TRH was greater in elderly men. A more prolonged release of luteinizing hormone was evident in men with prostatic cancer. Higher estradiol and estrone but lower androstenedione levels occurred in men with prostatic cancer. Data suggest that, in the elderly South African black men with prostatic cancer, estrogen metabolism is modified and that either the estrogen level or the higher estrogen:androgen levels modify the pituitary response to LHRH:TRH. A Western diet enhanced the changes in hormone profiles evident in black South African men with prostatic cancer.

Prostate. 1982;3(1):73-80.

Cancer of the prostate and aging: an autopsy study in black men from Washington, DC, and selected African cities.

Kovi J, Jackson MA, Rao MS, Heshmat MY, Akberzie ME, Williams AO, Christian EC.

Age-related changes of arteries, veins, glands, and stroma in the prostate of black men from Washington, DC, and from Ibadan, Nigeria, and Accra, Ghana, West AFrica, were studied in a total of 795 consecutive, unselected prostate specimens removed at autopsy during a 7-year period (1973-1980). Except for age group 80 and over, aging changes in the prostate were more severe in all age groups in black men from Washington, DC, than in black men from Ibadan and Accra (P less than 0.01). However, when the intensity of age-dependent alterations was compared in either US or African black men with carcinoma and with no carcinoma, no significant differences were found. These findings do not support the idea that the aging process per se increases susceptibility to cancer.

East Afr Med J. 1981 Oct;58(10):732-7.

Latent carcinoma of the prostate in Uganda.

Drury RA, Owor R.

Int Urol Nephrol. 1981;13(2):159-66.

Prostatic carcinoma in Nigeria: a 10-year retrospective study.

Udeh FN.

Trans R Soc Trop Med Hyg. 1980;74(6):749-51.

Orchidectomy in a rural African population.

Mabogunje OA, Grundy DJ, Lawrie JH.

From 1971 to 1977 in Zaria, Nigeria, orchidectomy was performed on 341 men, mostly in the third to sixth decades of life. The testis itself was diseased only in 21% of cases. Torsion of the spermatic cord with testicular infarction occurred in 11% and cancer was present in less than 2%. Orchidectomy was performed therapeutically in 5% of the patients. The major causes for testicular resection were complicated and large inguinal herniae and hydroceles. These two conditions are a source of socio-economic hardship and considerable morbidity in a farming population. It would thus be worth while to include facilities for surgery of small herniae and hydroceles in plans for rural health care.

West Afr Med J Niger Med Dent Pract. 1973 Dec;22(6):108-11.

Primary carcinoma of the prostate in Ibadan.

Nkposong EO, Lawani J

S Afr J Surg. 1973 Jun;11(2):89-90.

Carcinoma of the prostate in the Bantu.

Lissoos I.

J Urol. 1968 Mar;99(3):316-20.

The Bantu prostate: a study of prostatic disease in Central Africa.

Houston W.

A Clue to Racial Differences in Prostate Cancer? Pilot Study Suggests Biological Basis
2003/11/17 Doctors have long known that prostate cancer is more deadly in African American men and strikes them at younger ages than men of other races. What they don’t know is why that’s so.

A small pilot study published in The Journal of Urology (Vol. 170, No. 3: 990-993) may offer up a clue.

Researchers at the University of North Carolina, Chapel Hill, found higher levels of androgen receptor protein, a protein that helps stimulate prostate cancer, in tissue samples taken from black men compared to tissue samples taken from white men.

“To my knowledge, this is the first biological difference found between the two races that could explain the difference in aggressiveness of prostate cancer in African American men,” said study co-author James Mohler, MD, who left North Carolina in May to become chair of the department of urologic oncology at Roswell Park Cancer Institute in Buffalo, New York.

But, he cautions, it’s too early to say for sure that the mystery has been solved.

“This is a very, very preliminary finding … that needs to be confirmed before anybody attaches any significance to it,” he said. Just 50 Men Studied

Mohler and his colleagues examined prostate tissue samples from 25 African American men and 25 white men whose prostate had been removed after they were diagnosed with localized prostate cancer. The men were similar in age, and had similar cancer stages and degrees of spread.

The cancerous tissue taken from the black men had 81% more androgen receptor protein than cancerous tissue from the white men. Even the prostate tissue that didn’t have cancer had 22% more androgen receptor protein in the African American men.

That means that the normal prostate tissue in this group of African American men was more stimulated to develop cancer, and the cancer that had already developed was more stimulated to grow, Mohler said.

He had not expected to find such a difference. “I was very surprised by these findings, so we’re trying to confirm them in a very large study.”

University of California, Davis, Health System May 13, 1998

STUDY SUGGESTS BCL-2 GENE AS CAUSE FOR AGGRESSIVE PROSTATE CANCER IN AFRICAN AMERICAN MEN
Findings underscore need for early screenings to reduce mortality in this ethnic group.

(SACRAMENTO, Calif.) — A gene that blocks cells from dying may play a role in prostate cancer in African Americans, offering a new hypothesis as to why black men have the highest rate of prostate cancer in the world. The findings appear in the June issue of the Journal of Urology.

“African-American men develop prostate cancer earlier and in a more aggressive form than any other ethnic group,” says Ralph W. deVere White, director of the UC Davis Cancer Center and lead author of the Journal of Urology study. “They are more likely to die from the disease and more frequently have a recurrence after treatment with radical prostatectomy, the surgical removal of the prostate gland. Even when consideration is given to diet, lifestyle, or socioeconomic factors, the differences in the behavior of prostate cancer between the races remains unexplained.”

But collaborative research done at UC Davis School of Medicine and Medical Center, Howard University in Washington, D.C., and the Northern California Cancer Center in Union City, Calif., suggests that the difference in prostate cancer pathophysiology in African Americans may lie in altered expression of bcl-2, a gene that plays a central role in preventing cells from dying.

In all cells, a series of genes plays an integrated role in allowing the cell to progress through the cell cycle, DNA replication, and cell division. At the same time, a separate set of genes, interrelated with those that govern the cell cycle, work to allow the cell to enter programmed cell death, or apoptosis, at the appropriate time.

This can occur as a natural part of cell aging, or in response to DNA damage. Cancers can grow either by an increase in proliferation, a decrease in apoptosis, or both. In prostate cancer, the gene bcl-2 acts as a major block to cell death.

In the Journal of Urology study, the researchers evaluated four markers of tumor aggressiveness in cancerous prostates removed from 43 black and 74 Caucasian men to determine which factors were related to racial differences. The markers include:

— DNA ploidy, the number of extra chromosomes in the nucleus

— proliferation, the degree of tumor growth

— p53, a gene that is overexpressed in many cancers and predicts tumor progression

— bcl-2, a gene that blocks cell death

While no significant differences in levels were found in three of the four markers in these two groups of men, the researchers found a connection between bcl-2 levels and the more aggressive tumors found in the prostates removed from black men. They also found both low-and high-grade black prostate tumors had similar DNA ploidy distributions, rather than a higher degree of abnormality for the high-grade tumors as would be expected.

“Our studies suggest that in African Americans, tumor growth is more rapid because fewer cells are instructed to die,” says deVere White. “With the bcl-2 gene overexpressed, it causes prostate cancer cells to flourish when they would normally perish. And because the chances that a prostate cancer tumor will metastasize increases with tumor size, it makes sense that if programmed cell death is blocked, metastasis could occur earlier in the course of the disease.”

Drs. deVere White and Aaron Jackson, Chief of the Division of Urology at Howard University and a co-author of the study, say that more study is needed to determine the significance of bcl-2 and how it interacts with other genes.

Yet, since this study helps to explain why cancers occur earlier and more aggressively in African American men, it also underscores the importance of screening measures in this ethnic group, says Jackson.

More than 300,000 men are diagnosed with prostate cancer each year, and more than 40,000 will die from the disease. Warning signs for prostate cancer include inability to urinate, blood in the urine, and pain or burning during urination. In its beginning stages, however, prostate cancer has no symptoms.

“In its early stages, prostate cancer is silent,” says Dr. Jackson. “A person cannot make a diagnosis of prostate cancer on themselves based on symptoms.” As a result, Howard recommends that African American men and those who have a family history of prostate cancer undergo a physical exam and a prostate-specific antigen (PSA) test when they turn 40, with regular checks every year thereafter.

The encouraging news from the study, says deVere White, is that “if these cancers are detected while they are very small, there is no difference in survival rates between black and whites. And the overall cure rate for prostate cancer caught in its earliest stages is greater than 90 percent.”
Prostate Cancer in African-American Men Excerpt from a report from the National Cancer Institute’s (NCI) Cancer Information Service –
May 1998 NCI-supported researchers conducted a case-control study of prostate cancer among men in the United States and Canada who are at high risk (African-Americans), moderate risk (whites), and low risk (Asian-Americans) for the disease. The study assessed the contributions of diet, physical activity, and body size to the observed ethnic differences in risk.

Although researchers found no consistent evidence of a relationship between prostate cancer risk and either body mass or physical activity, increased risk of prostate cancer was found to be associated with high intake of saturated fat in each of the ethnic groups studied. Other factors such as genetically determined hormone levels and diet during adolescence may account for differences in incidence among the ethnic groups studied.

Five-year survival rates are lower for African-American men (66.4 percent during 1983 to 1990) than for white men (81.3 percent during 1983 to 1990). This difference is due, in part, to the fact that African-American men tend to be diagnosed at later stages of the disease. But, even within stages, survival rates are lower for African-Americans.

African-American men have considerably higher incidence rates (209.6 cases per 100,000 African-American men in 1991) than white men (159.2 cases per 100,000 white men in 1991).

African-American men may have the highest rate of prostate cancer incidence in the world. In addition, their prostate cancer mortality rate is twice as high as the rate for white Americans. In 1991, mortality rates were 24.7 cases per 100,000 white men, and 55.1 cases per 100,000 African-American men. Mortality rates also are increasing much more rapidly among African-American men (about 1.8 percent annually from 1973 to 1991) than among whites (about 1.0 percent annually).

The causes of higher rates of prostate cancer among African-American males are largely unknown. An NCI study found that even when income and education are controlled for, African-Americans have much higher rates than whites. An NCI-supported study is being conducted in three areas of the United States to investigate the reasons for African-Americans’ high rates of prostate cancer and other cancers. This case-control study will examine the impact of a wide variety of potential risk factors, including dietary and other lifestyle differences, occupational exposures, and hormonal and genetic differences

November 21, 2001

Prostate-cancer rate high for Orange County’s black men

By Matt Smith
Ottaway News Service

Albany – Orange County has one of the highest incidence rates in New York state of prostate cancer among black men.
That’s according to the state Department of Health, which yesterday released figures showing that for every 100,000 black men, 150 or more in Orange County were diagnosed with the disease between 1994 and 1998.
Meanwhile, the prostate-cancer rates among whites in the county during the same period was 112 to 124.9 per 100,000.
The elevated prostate-cancer rate among black men puts the growing mid-Hudson area in a dubious league with some of the state’s largest counties, including Erie, Suffolk, Monroe, Nassau and Queens.
But the factor driving the rate in Orange County – or anywhere else for that matter – is not exactly clear.
Health Commissioner Antonia Novello said the the disease accounts for 40 percent of all cancers diagnosed among black men.
Still, Novello said that while economic and cultural factors may contribute to the higher incidence rate among black men, little is known about what causes the disease.
There has been some evidence linking diet to cancer risk, and scientists are now studying ways to lower those risks with dietary supplements.
“The same diet you follow for your heart,” Novello said, “is the same diet you should follow for your prostate.”
In Ulster County, meanwhile, the prostate-cancer incident rate among black men between 1994 and 1998 was 125 to 149 per 100,000 men. That’s slightly more than the rate among whites in the county, which was 112 to 124.9 per 100,000 men.
The rate of prostate cancer among black men in Sullivan County was less than 112 per 100,000. That incidence rate was lower than the rate for whites, which totaled 125 to 149 per 100,000.
Health officials noted that with the introduction of the Prostate Specific Antigen tests in the late 1980s, cancer incidence rates in both black and white men increased. But, while the incidence rate among white men peaked in the mid-1990s, the increased prostate-cancer rate among black men has remained.
Novello yesterday urged men over the age of 50 to be tested.
Pointing out that New York requires health maintenance organizations, Medicaid and Medicare to cover PSA screening, the commissioner said men “in this state have no reason” not to be tested.

Bad Gene Ups Prostate Cancer Risk in Black Men
Mutation also plays role in disease development for white men
WEDNESDAY, July 9 (HealthDayNews) — A gene called macrophage scavenger receptor 1 (MSR1) plays an important role in the development of prostate cancer in black American men.

So says a study in the July 1 issue of Cancer Research .

The finding comes from a larger project called the Flint Men’s Health Study, which is meant to identify prostate cancer risk factors in black American men.

“African-American men have the highest incidence of prostate cancer in the world. The severity is higher and they tend to die more quickly after diagnosis,” study author Dr. Kathleen Cooney, an associate professor of internal medicine at the University of Michigan Comprehensive Cancer Center, says in a statement.

“We don’t know why this is, but part of the difficulty is that African-American men are underrepresented in most genetics studies,” Cooney says.

This study included black men, aged 40 to 79, living in Flint, Mich. DNA samples were collected from 134 men diagnosed with prostate cancer and 340 men without the disease. After analyzing the DNA samples, the researchers concluded that rare germ-line MSR1 mutations were associated with an increased risk of prostate cancer.

Previous studies found the same association in white men.

“This study adds to an expanding body of evidence in support of germ-line MSR1 mutations as risk factors for prostate cancer. Although our study was modest in size, the public health burden of prostate cancer in the African-American community warrants further attention to potential genetic risk factors,” lead author Dr. David Miller, a urology resident at the University of Michigan Medical School, says in a news release.

SOURCE: University of Michigan, news release, July 2003

Prostate cancer test works as well for black men, study shows from Johns Hopkins March 4 2000
A new twist on the standard way to predict prostate cancer risk appears to offer African-American men a much-needed, improved accuracy in detecting the disease.

A review of data from a recent nationwide trial of the free prostate specific antigen test (fPSA) a variation on the traditional PSA test shows the new test proves as accurate in revealing cancer risk in African American men as it is in Caucasians.

“It also shows that many African-American men could be spared the expense and trauma of prostate biopsies,” says Johns Hopkins urologist Alan W. Partin, M.D., Ph.D., co-leader of the research team. “Nearly 75 percent of the prostate biopsies that both black and white men get are unnecessary,” says Partin.

A report on the study at Johns Hopkins and six other U.S. medical centers appears in the March issue of the journal Urology.

The fPSA, a more sensitive test for cancer risk than the standard PSA test men get as part of routine physicals, won Food and Drug Administration approval two years ago, based on a national trial of 773 men who had both tests as well as prostate biopsies. This earlier trial showed that fPSA detected 95 percent of the cancers.

It also reduced unnecessary prostate biopsies that men would have routinely after the standard PSA test.

A variety of races took part in this original trial, which compared the two tests as detectors of prostate cancer. “But because the trial was composed mostly of Caucasian men,” Partin says, “we saw a need to re-analyze the data specifically for the subset of African-Americans, who are at far higher risk.”

The new analysis shows no significant differences exist between blacks and whites in the performance of the fPSA test.

Since FDA approval, the fPSA is becoming a follow-up test for men whose PSA falls in a “diagnostic gray zone” of moderately elevated levels–4 /to 10 ng/ml. The risk of prostate cancer in this group is 25 percent in Caucasians and 30 to 50 percent in African-American men. Prior to development of the free PSA test, men in the “gray zone” had to undergo biopsies, often repeated. Prostate biopsies are expensive around $1,000 and may be painful or psychologically traumatic, says Partin.

“Because early detection is currently our best hope against prostate cancer,” says Partin, “it’s crucial that we can rely on effective screening tools like the free and total PSA tests regardless of the patient’s race.”

“African-American men have the highest rate of prostate cancer in the world,’ says Partin. It’s approximately one-third greater than for white males. They also have higher PSA values when the cancer is diagnosed. “No one understands the precise reason for this,” he adds, “though theories abound. It’s probably a combination of biological and environmental factors.”

PSA is an enzyme made by all prostate cells and normally secreted into semen. Both cancer and a number of benign conditions can change the architecture of the prostate gland so the enzyme “gets out the back door” and into the bloodstream. Once there, PSA can exist in two forms one that’s free-floating and another that’s bound to proteins. The standard PSA test measures both forms. The free PSA test looks at the ratio of the free form to the total.

“For some reason,” says Partin, “having a higher amount of free PSA is linked with a lower risk of prostate cancer.”

Study evaluates biology of prostate cancer progression in African-American men University of Texas M. D. Anderson Cancer Center 6-Apr-2003
TORONTO – Despite the fact that the death rate from prostate cancer is much higher in African-American men than in Caucasian men, little is known if prostate cancer biology could be different among the two racial groups. Researchers at The University of Texas M. D. Anderson Cancer Center are exploring differences in the molecular behavior of the cancer between the two groups.

Their small and preliminary study, was published in the Proceedings for the 2003 Annual Meeting of the American Association of Cancer Research, is important because the onset and progression of the disease appear to differ depending on race, but researchers do not know if this is a result of biological differences.

“Prostate cancer in African American men appears to behave aggressively, and that could be due to differences in the cancer’s behavior and gene expression, or to delays in seeking treatment,” says Curtis Pettaway, M. D., an associate professor in the Department of Urology and Cancer Biology.

The study was undertaken as part of a project that seeks to develop a novel test capable of predicting whether prostate cancer will metastasize, or spread, beyond the prostate organ.

Researchers are measuring the expression levels of two genes that paint a picture of whether or not cancer has moved beyond the confines of the prostate organ. One is the adhesion molecule E-cadherin which helps cells stick to each other. Low levels of E-cadherin are associated with cancer metastasis. Expression of two other molecules, matrix metalloproteinases (MMP 2 and 9), correlates strongly with aggressive prostate cancer.

Examining tissue samples from 21 African-American patients who had their cancerous prostates removed, Pettaway and his colleagues found that the ratio of MMP to E-cadherin accurately predicted which cancers had spread beyond the organ and which had not. A lot of MMP and little E-cadherin suggested the cancer had become invasive, where as less MMP and more E-cadherin predicted the cancer had stayed confined to the organ. The same trend was seen in a previous study of 40 Caucasian patients, Pettaway says. The investigators are planning a much larger study to actually compare the expression of these two genes among African American and Caucasian men with prostate cancer.

The test may someday be used, along with other risk analyses, to help patients and physicians decide on the best type of therapy based upon the test’s prediction of whether the cancer has spread, he says.

British Journal of Cancer (2004) 90, 510-514.
doi:10.1038/sj.bjc.6601417

Hereditary prostate cancer in African American families: linkage analysis using markers that map to five candidate susceptibility loci

W M Brown1, E M Lange1, H Chen2,3,4, S L Zheng5, B Chang5, K E Wiley6, S D Isaacs6, P C Walsh6, W B Isaacs6, J Xu1,5 and K A Cooney2,3,4

1Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA

2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA

3Department of Urology, University of Michigan Medical School, Ann Arbor, MI 48109, USA

4Ann Arbor Department of Veteran’s Affairs, Ann Arbor, MI 48109, USA

5Center for Human Genomics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA

6Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA

African American men have the highest incidence of prostate cancer in the world. Despite this statistic, linkage studies designed to localise prostate cancer susceptibility alleles have included primarily men of Caucasian descent. In this report, we performed a linkage analysis using 33 African American prostate cancer families from two independent research groups. In total, 126 individuals (including 89 men with prostate cancer) were genotyped using markers that map to five prostate cancer susceptibility loci, namely HPC1 at 1q24-25, PCAP at 1q42.2-43, CAPB at 1p36, HPC20 on chromosome 20, and HPCX at Xq27-28. Multipoint mode-of-inheritance-free linkage analyses were performed using the GENEHUNTER software. Some evidence of prostate cancer was detected to HPC1 using all families with a maximum NPL Z score of 1.12 near marker D1S413 (P=0.13). Increased evidence of linkage was observed in the 24 families with prostate cancer diagnosis prior to age 65 years and in the 20 families with male-to-male transmission. Some evidence of prostate cancer linkage was also detected at markers mapping to PCAP, HPC20, and HPCX. Continued collection and analysis of African American prostate cancer families will lead to an improved understanding of inherited susceptibility in this high-risk group.