Abstract
Objectives To evaluate if the different results of prostate cancer risk between black and white Brazilian men may be associated with the varying methodology used to define participants as either Blacks or Whites.Patients and Methods We evaluated median PSA values, rate of PSA level ≥4.0 ng/mL, indications for prostate biopsy, prostate cancer detection rate, biopsy/cancer rate, cancer/biopsy rate, and the relative risk of cancer between blacks versus whites, blacks versus non-blacks (browns and whites), non-whites (browns and blacks) versus whites, African versus non-African descendants, and African descendants or blacks versus non-African descendants and non-blacks.Results From 1544 participants, there were 51.4% whites, 37.2% browns, 11.4% blacks, and 5.4% African descendants. Median PSA level was 0.9 ng/mL in whites, browns, and non-African descendants, compared to 1.2 ng/mL in blacks, and African descendants or blacks, and 1.3 ng/mL in African descendants. Indications for prostate biopsy were present in 16.9% for African descendants, 15.9% of black, 12.3% of white, 11.4% for non-African descendants, and 9.9% of brown participants. Prostate cancer was diagnosed in 30.3% of performed biopsies: 6.2% of African descendants, 5.1% of blacks, 3.3% of whites, 3.0% of non-African descendants, and 2.6% of browns.Conclusions Median PSA values were higher for Blacks versus Whites in all classification systems, except for non-white versus white men. The rate of prostate biopsy, prostate cancer detection rate, and relative risk for cancer was increased in African descendants, and African descendants or blacks, compared to non-African descendants, and non-African descendants and non-blacks, respectively.
Highlights
Prostate cancer is the most common visceral malignant neoplasm in men
To evaluate if the heterogeneous methodology of racial/ethnic classification may be responsible for the different risk assessments for prostate cancer in Black and White Brazilian men, we stratified a single cohort of men undergoing prostate cancer screening within five working systems of classification, and compared the median PSA values, rate of PSA level ≥4.0 ng/mL, indications for prostate biopsy, prostate cancer detection rate, biopsy/cancer rate, cancer/ biopsy rate, and the relative risk of cancer between Black and White groups within each racial/ ethnic classification system
Based on several classifications systems used to stratify a single cohort of Brazilian men in different groups of Blacks and Whites, median PSA values were higher in Black versus White groups classified as blacks versus whites, blacks versus non-blacks, African descendants versus non-African descendants, and African descendants or blacks versus non-African descendants and non-blacks
Summary
Prostate cancer is the most common visceral malignant neoplasm in men. The incidence of prostate cancer varies according to racial differences in several countries, as well as the estimated lifetime risk of disease and the mortality rate for cancer [1,2,3].Black men have the highest reported incidence of prostate cancer in the World, with a relative risk of 1.6 compared with white men in the United States (US) [1, 2]. In Brazil, most studies demonstrated a similar risk of prostate cancer between Black and White men [4,5,6,7,8,9,10,11], while only some verified an increased prevalence of prostate cancer in Black participants, compared to White ones [12,13,14] These results have been frequently attributed to the high race mixture index in the Brazilian population as a consequence of centuries of interethnic crosses between Europeans, Africans, and Amerindians, but they may as well be the result of the different methodology used to define participants as either Blacks or Whites in each study, because there is still no consensus in the Brazilian society [15, 16]
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