A performative autoethnography of five Black American men

Malignant transformation of the prostate and progression of carcinoma appear to be the consequence of a complex series of initiation and promotional events under genetic and environmental influences. Increased incidence of the condition may be the result of improved detection, greater awareness of the condition, and possibly an increased life expectancy accompanied by a decrease in competing causes of death rather than a true increase in the prevalence of the disease. The marked racial and geographic differences are probably multifactorial, with genetic, environmental, and possibly social influences affecting progression of the disease. Among several risk factors, evidence for the familial inheritance of some prostate cancers is compelling. Dietary influences, hormonal milieu, and the role of environmental carcinogens are currently under intense investigation. As further risk factors are identified, it will become increasingly important to identify individuals at increased risk for the disease. These men should undergo regular evaluation with state-of-the-art methods.

Re-Examining Racial Disparities in Prostate Cancer Outcomes

Introduction: African American (AA) men experience greater prostate cancer (PC) incidence and mortality compared to European American (EA) men, but the reasons are not fully understood. Some literature has identified connections between neighborhood disadvantage and aggressive PC, and AA men may be more likely to experience these factors than EA men. However, it is unclear if these associations may vary by race. We tested associations of two neighborhood disadvantage measures (neighborhood socioeconomic deprivation and racial segregation) with prostate tumor aggressiveness, overall and separately by race. We hypothesized that they would be positively associated and that associations would be stronger among AA men. Methods: We leveraged data from the University of Maryland Greenebaum Comprehensive Cancer Center Tumor Registry for AA and EA men who were diagnosed with PC from 2004-2021. We geocoded participants’ addresses at diagnosis to determine census tract-based Area Deprivation Index (ADI) and Racial Isolation Index (RI) values. ADI analyses included men diagnosed in 2005 or later (778 AA men and 687 EA men), and RI analyses included men diagnosed in 2009 or later (606 AA men and 454 EA men) based on data availability. We used logistic regression to model the odds of aggressive PC, defined as a Gleason pattern of 4+3 or a total Gleason score >=8, overall and by race. We fit models with scaled ADI or RI as the exposure variable, adjusting for race, age at diagnosis, and year of diagnosis. We also assessed an interaction between each neighborhood measure and race. Results: Median (interquartile range) ADI scores were 118 (101-137) for AA men and 92 (83-102) for EA men, and RI scores were 0.68 (0.35-0.87) for AA men and 0.11 (0.06-0.20) for EA men, indicating greater neighborhood deprivation and AA residential segregation among AA participants. The greatest values for these scores were concentrated in central and west Baltimore. A one-standard deviation (SD) increase in ADI was associated with significantly greater odds of aggressive tumors for AA men (OR=1.28, 95% CI: 1.10, 1.49; p<0.01), but not for EA men (OR=0.85, 95% CI: 0.67, 1.08; p=0.19), and the p-value for interaction (p<0.01) was statistically significant. Similarly, a one-SD increase in RI was significantly associated with aggressive tumors for AA men (OR=1.24, 95% CI: 1.03, 1.49; p=0.03), but not for EA men (OR=1.23, 95% CI: 0.84, 1.80; p=0.29), although the p-value for interaction was not statistically significant. Conclusions: Neighborhood disadvantage was significantly associated with higher odds of aggressive PC. The association of neighborhood deprivation and tumor aggressiveness was stronger among AA men. Additional analyses will consider other measures, including historical redlining, to further evaluate the relationship of neighborhood disadvantage with prostate tumor aggressiveness. Citation Format: Joseph Boyle, Jessica Yau, Jimmie L. Slade, Derrick A. Butts, Jessica Wimbush, Jong Y. Park, Arif Hussain, Eberechukwu Onukwugha, Cheryl L. Knott, David C. Wheeler, Kathryn Hughes Barry. Neighborhood disadvantage and prostate tumor aggressiveness among African American and European American men [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 809.

Racial disparities in prostate cancer care: Is adherence to National Comprehensive Cancer Network guidelines good enough for our patients?

INTRODUCTION: African American (AA) men experience greater prostate cancer incidence and mortality compared to European American (EA) men. Growing literature supports associations of neighborhood social factors (NSF) including neighborhood socioeconomic deprivation and residential segregation with advanced or aggressive prostate cancer, and AA men may experience these factors to a greater extent than EA men. Here we tested associations of NSF with prostate tumor RNA expression of stress-related genes, hypothesizing that these factors would be related and contribute to prostate tumor aggressiveness. METHODS: We leveraged available transcriptomic data from prostate tumor tissue for AA and EA men with prostate cancer who received radical prostatectomy surgery at the University of Maryland Medical Center. We geocoded each participant’s address at diagnosis, determined the corresponding census tract, and assigned tract-based Area Deprivation Index (ADI) and Racial Isolation Index (RI) scores to each participant. Based on data availability, ADI analyses included men diagnosed in 2005 or later (118 AA men and 43 EA men), and RI analyses included those diagnosed in 2009 or later (110 AA men and 37 EA men). We evaluated 105 stress-related genes, including those in the Conserved Transcriptional Response to Adversity, among others. We fit separate linear regression models for expression of each gene in relation to ADI or RI, respectively. Models were adjusted for race and age and year at surgery. We obtained q-values (p-values adjusted for multiple comparisons) using the Benjamini-Hochberg method. RESULTS: Median (interquartile range) ADI scores were 116 (101-131) for AA men and 91 (83-103) for EA men, and RI scores were 0.68 (0.38-0.87) for AA men and 0.10 (0.05-0.14) for EA men, indicating greater neighborhood deprivation and Black residential segregation among AA participants. The greatest values for these scores were concentrated in central and west Baltimore. ADI scores were positively and significantly (p<0.05) associated with expression for 11 genes. One gene, HTR6 (serotonin pathway), remained significant after multiple comparison adjustment (beta=0.0029, 95% confidence interval: 0.0014-0.0043; p<0.001; q=0.02). RI scores were positively and significantly associated with expression for 7 genes (p<0.05), but findings did not remain significant after multiple comparison adjustment. Four genes, including HTR6, IFIT2 and MX2 (roles in Type I IFN response), and IGLL1 (antibody synthesis) were significantly associated with both ADI and RI (p<0.05). Top findings among AA men only were similar to the overall results (AA and EA men combined). CONCLUSIONS: We identified several genes in stress-related pathways whose expression in prostate tumor tissue was higher among men with higher neighborhood deprivation or higher racial segregation. Additional analyses will consider other neighborhood measures, including historical redlining, to further investigate the role of NSF in prostate tumor RNA expression, tumor aggressiveness, and prostate cancer disparities. Citation Format: Joseph Boyle, Jessica Yau, Jimmie L. Slade, Derrick Butts, Yuji Zhang, Teklu B. Legesse, Ashley Cellini, Kimberly Clark, Jessica Wimbush, Nicholas Ambulos Jr., Jing Yin, Arif Hussain, Eberechukwu Onukwugha, Cheryl L. Knott, David C. Wheeler, Kathryn Hughes Barry. Neighborhood socioeconomic deprivation, racial segregation, and prostate tumor RNA expression of stress-related genes among African American and European American men [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR007.

African American men have the highest rates of prostate cancer incidence and mortality in the United States. Understanding underlying reasons for this disparity could identify preventive interventions important to African American men. To determine whether the association of obesity with prostate cancer risk differs between African American and non-Hispanic white men and whether obesity modifies the excess risk associated with African American race. Prospective study of 3398 African American and 22,673 non-Hispanic white men who participated in the Selenium and Vitamin E Cancer Prevention Trial (2001-2011) with present analyses completed in 2014. Total, low-grade (Gleason score <7), and high-grade (Gleason score ≥7) prostate cancer incidence. With a median (interquartile range) follow-up of 5.6 (1.8) years, there were 270, 148, and 88 cases of total, low-, and high-grade prostate cancers among African American men and a corresponding 1453, 898, and 441 cases in non-Hispanic white men, respectively. Although not associated with risk among non-Hispanic white men, BMI was positively associated with an increase in risk among African American men (BMI, <25 vs ≥35: hazard ratio [HR], 1.49 [95% CI, 0.95, 2.34]; P for trend = .03). Consequently, the risk associated with African American race increased from 28% (HR, 1.28 [95% CI, 0.91-1.80]) among men with BMI less than 25 to 103% (HR, 2.03 [95% CI, 1.38-2.98]) among African American men with BMI at least 35 (P for trend = .03). Body mass index was inversely associated with low-grade prostate cancer risk within non-Hispanic white men (BMI, <25 vs ≥35: HR, 0.80 [95% CI, 0.58-1.09]; P for trend = .02) but positively associated with risk within African American men (BMI, <25 vs ≥35: HR, 2.22 [95% CI, 1.17-4.21]; P for trend = .05). Body mass index was positively associated with risk of high-grade prostate cancer in both non-Hispanic white men (BMI, <25 vs ≥35: HR, 1.33 [95% CI, 0.90-1.97]; P for trend = .01) and African American men, although the increase may be larger within African American men, albeit the racial interaction was not statistically significant (BMI, <25 vs ≥35: HR, 1.81 [95% CI, 0.79-4.11]; P for trend = .02). Obesity is more strongly associated with increased prostate cancer risk among African American than non-Hispanic white men and reducing obesity among African American men could reduce the racial disparity in cancer incidence. Additional research is needed to elucidate the mechanisms underlying the differential effects of obesity in African American and non-Hispanic white men.

Racial Disparities in Palliative Radiation for African American Men with Metastatic Prostate Cancer

Background: African American (AA) men have the highest mortality rate from prostate cancer compared to men from other races. Differences in the spectrum of somatic genomic alterations in tumors between AA men differs from non-AA men has not been well characterized as relatively few AA men have been included in prostate cancer genomic studies. To address this, we examined 5 publicly-available and commercial genomic datasets containing AA men with prostate cancer to identify novel alterations associated with race. Methods: In a meta-analysis of 4 public datasets, we investigated the mutational frequencies of 14 genes across 252 AA men and 635 non-AA men with primary prostate cancer. We also examined genomic alterations from the tumors of 436 AA men and 3018 EA men with primary or metastatic prostate cancer using the Foundation One assay. Results: We identified mutations in ZFHX3 and focal deletions in ETV3 more frequently in tumors from AA patients. The mutational frequency of TP53 was strongly associated with increasing Gleason grade. Using the commercial assay, we identified alterations in PTEN and TMPRSS2-ERG as less frequent in AA patients compared to non-AA patients in both primary and metastatic tumors. MYC amplifications were more frequent in AA patients with metastatic prostate cancer. Furthermore, we found that genomic alterations in KMT2D and CCND1 were more frequent in primary prostate tumors from AA patients, resulting in differential cell cycle genes and KMT alterations. MYC amplifications were more frequent in AA patients with metastatic prostate cancer. Genomic alterations in DNA repair genes were found at similar frequencies between EA and AA patients. Conclusion: While these results indicate that differences in mutational profiles may exist between racial groups in prostate cancers, additional sequencing studies that profile AA and EA men from the same clinical setting and that are matched for clinical covariates may be needed to confirm these findings. Overall, these results have implications for applying precision cancer medicine in AA prostate cancer patients. Citation Format: Yusuke Koga, Hanbing Song, Zachary Chalmers, Justin Newberg, Garrett Frampton, Joshua Campbell, Franklin Huang. Similarities and differences between genomic profiles of prostate cancers from African American and European American men with implications for precision cancer medicine [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D120.

Background: A diagnosis of hypertension (HTN) has been reported to be associated with an increased risk of total and aggressive prostate cancer (PCa) in some studies. In this study, we evaluated the association between HTN and total and lethal PCa in African-American (AA) and Caucasian-American (CA) men. Given that AA men are disproportionately burdened by both HTN and PCa, especially aggressive disease, we hypothesized that the positive association between HTN and total and lethal PCa is stronger in AA than CA men. We alternatively hypothesized that the positive association between HTN and PCa is the same in AA and CA men, but the higher HTN prevalence in AA men results in a greater PCa burden in AA men. Methods: We studied 1,590 AA men and 5,094 CA men from the Atherosclerosis Risk in Communities (ARIC) study without a history of cancer at the first study visit (1987-1989) and who were followed through 2012. HTN was defined based on clinic-measured systolic and diastolic blood pressure and self-reported use of antihypertensive drugs at Visit 1. First primary total PCa (N=266 in AA men, 565 in CA men) and lethal PCa (metastatic at baseline or progressed to death from prostate cancer, N=39 in AA men, 59 in CA men) were ascertained by cancer registry linkage, medical records, and death certificates. We used Cox proportional hazards regression to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of total and lethal PCa comparing CA men with HTN, AA men without HTN, and AA men with HTN to CA men without HTN. We adjusted for age, education, and purported risk factors including body mass index, waist to hip ratio, smoking, physical activity, diabetes, cholesterol-lowering medication use, and aspirin use. Results: AA men had a higher prevalence of HTN (54.6%) than CA men (28.6%) at baseline. Compared with CA men without HTN, CA men with HTN had a higher risk of total PCa (HR=1.23, 95% CI=1.01-1.49, p=0.040), and as expected, AA men without HTN had an elevated PCa risk (HR=2.41, 95% CI=1.94-3.01, p&amp;lt;0.001), but AA men with HTN had a similarly elevated PCa risk (HR=2.41, 95% CI=1.93-3.01, p&amp;lt;0.001). Patterns were similar for lethal PCa (versus CA men without HTN, CA men with HTN - HR=1.48, 95% CI=0.83-2.63, p=0.183, AA men without HTN - HR=3.27, 95% CI=1.79-5.95, p&amp;lt;0.001, AA men with HTN - HR=2.49, 95% CI=1.31-4.73, p=0.005). Conclusions: Our prospective findings support some prior studies that HTN is associated with an increased risk of total and possibly lethal PCa in CA men. Counter to our hypothesis, HTN was not associated with total or lethal PCa in AA men. Support: NHLBI, NCI, NPCR, UMMC Office of Research. Citation Format: Wanmei Wang, Eldrin Bhanat, Kenneth R. Butler, Corinne E. Joshu, Thomas H. Mosley, Elizabeth A. Platz, Christian R. Gomez. Association between hypertension and prostate cancer risk in black and white men in the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C090.

The status of African American boys and men is of significant concern. This article reviews the literature on African American males within the field of the psychology of men and masculinity. We focus on theory and research that describe African American men's masculinity, and how traditional masculinity and racial identity relate to the health and well-being of African American men. The article provides a context for introducing this special series of articles on African American men that advance our understanding of psychosocial factors associated with the health and well-being of African American men. Gibbs's classic 1988 book, Young, Black, and Male in America: An Endangered Species, brought much needed attention to the status of young African American males and suggested that there had been marked deterioration compared with past generations. Compared with earlier cohorts, young African American males were more likely to be unemployed, involved in the criminal justice system, unwed fathers, and victims of homicide and sui- cide. Almost 25 years later the status of African American boys and men continues to be an issue of significant concern. For example, African American men have the shortest life expectancy of all race/gender groups (National Center for Health Statistics, 2005). In 2006, the rate of new HIV infection for African American men was six times higher than European American men, nearly three times that of Hispanic/Latino men and twice that of African American women (Centers for Disease Control & Prevention, 2010). Further, African American men are six times more likely than European American men to be incarcerated (National Urban League, 2007). Lastly, the growth rate of African American men enrolling in college is the lowest among minority groups in the United States (Harvey, 2003). While these data are discouraging, other research has high- lighted strengths, progress, and psychosocial patterns character- ized by resilience. Compared with the national averages, African American men had lower rates of alcohol use and binge drinking from 2004-2008 (Substance Abuse & Mental Health Service Administration, 2010), and lower rates of mood disorders than both African American women and Whites (Breslau, Su, Kendler, Aguilar-Gaxiola, Kessler, 2005; Brown & Keith, 2003; Robins et

Prostate Cancer Stage Shift has Eliminated the Gap in Disease-free Survival in Black and White American Men after Radical Prostatectomy

Evidence exists that increased levels of physical activity decrease the population burden of cardiovascular disease (CVD). Although risk factors for CVD, including plasma lipids and lipoproteins, have been associated with physical activity, studies including a sizeable number of minority participants are lacking. Our purpose was to interrogate the longitudinal effect of physical activity on plasma lipids and lipoproteins in the African American and white participants of the Atherosclerosis Risk in Communities (ARIC) Study. Nine years of follow-up data on 8,764 individuals aged 45-64 years at baseline were used in linear mixed-effects models to estimate the association between increases in baseline physical activity on mean change in HDL, LDL, total cholesterol, and triglyceride levels. Increases in the level of activity were associated with increases in HDL in all strata and decreases in triglycerides among white participants. Physical activity was associated with LDL in all women, while the association with total cholesterol was limited to African American women. This study is one of the few to investigate the effect of physical activity on lipids and lipoproteins in a race- and sex-specific manner. Overall our results highlight the importance of physical activity on plasma lipid profiles and provide evidence for novel differential associations.

Osteoporosis Knowledge and Health Beliefs in African-American Men: Difference With Age

In the United States, African American (AA) men are at 60% higher risk of developing prostate cancer than European American (EA) men, and AA men are 2.4 times more likely to die from prostate cancer than EA men. Although these disparities are frequently attributed to the greater aggressiveness of prostate cancer among AA men, it is not known what causes that prostate cancer aggressiveness in AA men. To identify germline genetic variation that could explain some of this disparity, our previous admixture mapping study identified a novel region on chromosome 7q31-34 where local ancestry was associated with risk of disease. The main objective of this study is to investigate whether candidate genes in this gene region show differences in protein product expression by cell line origin (AA vs. EA) and by cell line metastatic potential. We specifically examined the expression of three proteins sourced from this gene region through immunoblot analysis, filamin C (FLNC), glutamate receptor metabotropic B (GRM8), and cadherin-like and PC-esterase domain containing 1 (CPED1). The cell lines DU-145, PC3, LNCaP, RWPE1, and WPE1 were derived from biological specimens from EA men, whereas the PCa2b and the RC77T cell lines were sourced from AA men. The RWPE1 and WPE1 cell lines were derived from normal prostate cells, while the remaining cell lines were derived from metastatic prostate cancers. Using immunoblot analysis, we found that GRM8 is expressed at higher levels in the cell lines derived from AA men with prostate cancer compared to those from EA men with prostate cancer. In contrast, FLNC and CPED1 are expressed at higher levels in the cell lines from EA men with prostate cancer compared to those from AA men with prostate cancer. Interestingly, both FLNC and CPED1 expression is also low in the androgen sensitive LNCaP cell line. Importantly, these results are consistent with our fine mapping results in AA men, where the SNP with greatest evidence for association is located. Further, previous studies have demonstrated that the methylation status and mRNA expression of CPED1 and FLNC differed between prostate cancers from AA and EA men. Taken together, these results provide us with a foundation to test the relevance of these genes in prostate cancer growth and metastasis and contribute to our understanding of the molecular differences in prostate cancer between EA and AA men. Citation Format: Casey Wizner, Julie Ruterbusch, Nicole Kubinec, Gregory Dyson, Albert Levin, Julie Boerner, Cathryn Bock. Determination of protein expression of candidate prostate cancer genes from a novel region on chromosome 7 identified in African American men. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B33.

6517 Background: Prostate cancer causes a disproportionate burden to AA men, and AA men are less likely than CA men to receive aggressive treatment. This is the first study to examine factors influencing treatment decision-making of AA vs. CA men in a population-based cohort. Methods: 1171 men were enrolled soon after diagnosis and before treatment through Rapid Case Ascertainment of the North Carolina state cancer registry. Researchers asked patients regarding their priorities in treatment decision-making and information sources. Differences in AA and CA men were compared using the chi-square test. Results: The most important factor for both AA and CA men was curing cancer, and preserving QOL was second most important. However, AA men were more concerned about additional factors including impact on daily activities (74% very important AA vs 58% CA for intermediate/high risk disease), recovery time (81% vs 50%), cost (66% vs 32%) and treatment time (76% vs 39%) (p &lt; .001 for each item). The most important source of information impacting treatment decisions for CA men were physician recommendations (61%), personal research (32%) and family/friend opinion (7%); for AA men, the corresponding numbers were 50%, 32% and 19%. Conclusions: AA and CA men with prostate cancer are both concerned about curing cancer, but AA men are more likely to consider multiple other social and personal factors as important in their decision-making process. Improved understanding of these differences may provide opportunities to address racial disparities in prostate cancer. [Table: see text]