Ethnic Incidence of Metastatic Prostate Carcinoma in a Veteran Affairs Medical Center’s (VAMC) And Early Surveillance Guided by Sites of Metastases

Abstract

Abstract Introduction/Objective Ethnic difference in incidence, mortality, and prognosis for prostate adenocarcinoma is well known with disparities between African American (AA), Caucasian and Asian origin population reported by tumor heterogeneity and increased number of gene mutations in genomic profiling. Early metastasis of prostate cancer with younger age at the presentation in AA ethnicity has been noted. Earlier screening, biopsy and tumor molecular profiling may lead to a decrease in morbidity and mortality related to metastatic prostate cancer. While there are known differences in the incidence of prostate cancer between different ethnic groups and differences in ethnic access to care and diagnosis varies widely between distinct medical practices, the ethnic incidence of diagnoses of metastatic prostatic adenocarcinoma and distribution of sites particularly in a Veteran population has not been well studied. Methods/Case Report A retrospective search was performed from December 2019 to October 2022 for metastatic prostatic carcinoma specimens at regional Veteran Affairs Medical Center (VAMC). Both H & E and immunohistochemical antibodies for prostate were reviewed and used in the diagnosis of metastatic carcinoma of prostate origin. Results (if a Case Study enter NA) A total of 21 cases with metastatic prostatic adenocarcinoma were found from which 9 were metastases to bone, 5 were metastases to lymph node and 7 were metastatic to other organ sites. Majority of the cases were of ethnic African American veterans (12/21, 57%), followed by Caucasian Americans (7/21, 33%), and 2 of unknown ethnicity (2/21, 10%). On examination, most frequent site of metastases by ethnic African Americans was lymph node in 4 out of the 5 (80%) total cases metastatic to lymph node, and 5 out of 6 total cases (83%) with metastases to different organ sites together. On the other hand, ethnic Caucasian Americans the most common metastatic site was bone with 6 out of 10 total cases (60%) metastatic to bone. Conclusion African American Veteran patients have a higher incidence of metastatic prostate carcinoma and a higher incidence of earlier metastases. A similar trend was seen in the study population with African Americans making up most of the study population and also suggestively having more cases of lymph node and other organ metastases. The increased proportion of African Americans in the study population with lymph node metastases suggests targeting lymph nodes for biopsy for early detection of the metastatic prostatic carcinoma.