Among African-American Men Research Articles

MP64-10 MRI-GUIDED BIOPSY TO EVALUATE PROSTATE CANCER SEVERITY IN AFRICAN-AMERICAN MEN

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP64)1 Apr 2020MP64-10 MRI-GUIDED BIOPSY TO EVALUATE PROSTATE CANCER SEVERITY IN AFRICAN-AMERICAN MEN Jorge Ballon, Ryan Chuang*, Adam Kinnaird, Rajiv Jayadevan, Steve Zhou, Danielle Barsa, Lorna Kwan, and Leonard Marks Jorge BallonJorge Ballon More articles by this author , Ryan Chuang*Ryan Chuang* More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , Rajiv JayadevanRajiv Jayadevan More articles by this author , Steve ZhouSteve Zhou More articles by this author , Danielle BarsaDanielle Barsa More articles by this author , Lorna KwanLorna Kwan More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000939.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The mortality rate of prostate cancer has long been considered higher among African-American (AA) men. Most diagnostic information has been obtained by ultrasound-guided prostate biopsy. To study the possibility that MRI-guided biopsy might provide histologic clarification of the apparent disparity, we studied use of the new modality in AA and other men at three time points in prostate cancer care: 1) at diagnosis, 2) during active surveillance, and 3) at final pathology after radical prostatectomy. METHODS: Subjects were 1002 consecutive men who underwent MRI-guided biopsy combining both systematic and lesion-targeted sampling between 2009-2018. Pathologic upgrading was defined as an increase in Gleason Grade group (GG) at structured follow-up biopsy during active surveillance (AS) or at whole-mount sectioning (prostatectomy). Statistical significance (p<0.05) was assessed using the Mann-Whitney-U test for continuous data, the Chi-square test (or Fisher's exact if necessary) for categorical data, and the Kaplan-Meier estimator to calculate progression-free survival probabilities. RESULTS: AA men (N=57) had higher rates of prostate cancer at diagnostic biopsy than other men (N=945) (79% AA vs 66% others; p=0.05). GG was similar in both groups: AA vs Other: GG <2, 25% vs 20%; GG3, 12% vs 10%; GG >4, 9% vs 9% (p=0.76). Upgrading at prostatectomy was found in 3/29 (10%) AA men and 32/262 (12%) other men (p=0.45). Among low-risk men in AS, Gleason upgrading during a median follow up of 4 years was found in 5/16 (31%) AA men and 93/274 (34%) other men (p=0.80). CONCLUSIONS: In our cohort studied with contemporary MRI-guided biopsy, aggressiveness of prostate cancer (judged histologically) was the same for both groups at initial biopsy, at prostatectomy, and during AS. Unlike similar investigations that used only ultrasound-guided biopsy, a method little changed from the 1980s, we found with the improved technology, no significant histologic differences between AA and other men at three important points in prostate cancer care. This suggests that differences previously observe were not based on physiology alone. Furthermore, these data indicate that after MRI-guided biopsy, entry into AS programs for AA men with prostate cancer is appropriate when low-risk pathology is determined using MRI-guided biopsy. Source of Funding: R01CA218547, R01CA195505 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e966-e967 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jorge Ballon More articles by this author Ryan Chuang* More articles by this author Adam Kinnaird More articles by this author Rajiv Jayadevan More articles by this author Steve Zhou More articles by this author Danielle Barsa More articles by this author Lorna Kwan More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF downloadLoading ...

Disparity in access to bariatric surgery among African-American men.

Despite improvements in safety and effectiveness in surgical management of extreme obesity, men and racial minorities are less likely to receive metabolic and bariatric surgery (MBS) compared to other patient groups. This study examines the racial and gender disparities in access to MBS to understand the mechanism that drives these problems and to propose strategies for closing the disparity gap. Using 2013-2014 National Health and Nutrition Examination Survey data, we estimated the proportion of individuals, by race and gender, who were eligible for MBS based on Body Mass Index (BMI) and comorbidity profile. We analyzed the 2015 MBS Accreditation and Quality Improvement Program Participant Use Data File to examine differences in patient characteristics, comorbidities, and postsurgical outcomes among African-American (AA) and White men. Predictors of poor outcomes were identified using unconditional logistic regression models. AA men represented 11% of eligible patients but only 2.4% of actual MBS patients. Compared to White men, AA men were younger, had higher BMI, were more likely to have a history of hypertension, renal insufficiency, required dialysis, and had American Society of Anesthesiologists class 4 or 5 (all P values < 0.01). After surgery, AA men were more likely to suffer from postoperative complications (adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.02-1.52) and stayed in the hospital for more than 4days (aOR 1.51, 95% CI 1.26-1.82) compared to White men. Despite being eligible for MBS based on both BMI and obesity-related comorbidities, AA men are significantly less likely to undergo MBS. Those AA men who receive surgery are significantly younger than White men but also experience greater comorbidities compared to White men and all women. Further longitudinal studies into patient-, system-, and provider-level barriers are necessary to understand and address these disparities.

Cigarette Smoking among Economically Disadvantaged African-American Older Adults in South Los Angeles: Gender Differences.

The current study aims to explore gender differences in the risk of cigarette smoking among African-American (AA) older adults who live in economically disadvantaged urban areas of southern Los Angeles. This cross-sectional study enrolled 576 older AA adults (age range between 65 and 96 years) who were residing in Service Planning Area 6 (SPA 6), one of the most economically challenged areas in southern Los Angeles. All participants had cardiometabolic disease (CMD). Data were collected using structured face-to-face interviews. Demographic factors (age and gender), socioeconomic status (educational attainment and financial difficulty), health (number of comorbid medical conditions and depressive symptoms), and health behaviors (current alcohol drinking and current smoking) were measured. Logistic regressions were used to analyze the data without and with interaction terms between gender and current drinking, depressive symptoms, and financial difficulty. AA men reported more smoking than AA women (25.3% versus 9.3%; p < 0.05). Drinking showed a stronger association with smoking for AA men than AA women. Depressive symptoms, however, showed stronger effects on smoking for AA women than AA men. Gender did not interact with financial difficulty with regard to current smoking. As AA older men and women differ in psychological and behavioral determinants of cigarette smoking, gender-specific smoking cessation interventions for AA older adults who live in economically deprived urban areas may be more successful than interventions and programs that do not consider gender differences in determinants of smoking. Gender-tailored smoking cessation programs that address drinking for AA men and depression for AA women may help reduce the burden of smoking in AA older adults in economically disadvantaged urban areas. Given the non-random sampling, there is a need for replication of these findings in future studies.

Racial Variations in Prostate Cancer Molecular Subtypes and Androgen Receptor Signaling Reflect Anatomic Tumor Location

Prostate cancer (PCa) subtypes based on ETS gene expression have been described. Recent studies suggest there are racial differences in tumor location, with PCa located anteriorly more often among African-American (AA) compared to Caucasian-American (CA) men. In this retrospective analysis of a multi-institutional cohort treated by radical prostatectomy (179 CA, 121 AA), we evaluated associations among molecular subtype, race, anatomic tumor location, and androgen receptor (AR) signaling. Subtype (m-ERG+, m-ETS+, m-SPINK1+, or triple-negative) was determined using distribution-based outlier analysis. AR signaling was investigated using gene expression profiling of canonical AR targets. m-ERG+ was more common in CA than AA men (47% vs 22%, p<0.001). AA men were more likely to be m-SPINK1+ (13% vs 7%; p=0.069) and triple-negative (50% vs 37%; p=0.043). Racial differences in molecular subtypes did not persist when tumors were analyzed by location, suggesting a biologically important relationship between tumor location and subtype. Accordingly, anterior tumor location was associated with higher Decipher scores and lower global AR signaling. Patient summaryThis study demonstrates associations among patient race, prostate cancer molecular subtypes, and tumor location. Location-specific differences in androgen regulation may further underlie these relationships.

Pathological outcome and biochemical recurrence‐free survival after radical prostatectomy in African‐American, Afro‐Caribbean (Jamaican) and Caucasian‐American men: an international comparison

To compare pathological and biochemical outcomes of radical prostatectomy (RP) among African-American (AA), Afro-Caribbean (AC; Jamaican) and Caucasian-American (CA) men using an international cohort of patients who underwent RP in the USA and Jamaica. A retrospective review was performed of men who underwent RP for clinically organ-confined (OC) prostate cancer between 2000 and 2011 at Columbia University Medical Center (New York, USA) and the University Hospital of the West Indies (Kingston, Jamaica) between 2000 and 2007. Men who had received neoadjuvant or adjuvant (within 3 months) therapy were excluded. Clinicopathological variables were compared among the three groups, focusing on age, stage, PSA level, Gleason sum (GS) and margin status. Multivariate analysis was performed to determine the predictors of biochemical recurrence (BCR; PSA >0.2 ng/mL), and Kaplan-Meier analysis was performed to determine BCR-free survival rates in AA, AC and CA men. A total of 483 men underwent RP for clinically OC disease (CM, n = 309, AA, n = 93 and AC, n = 81). The mean patient age was 59 years, with AA men being younger than CA men (58 vs 60 years, P< 0.05). The mean (range) follow-up was 49 (13-133) months with no significant difference among the groups. The men in the AC cohort had a higher mean PSA level than AA and CA men (8.8 vs 6.2 and 5.0 ng/mL, respectively, P< 0.05) and more clinical GS ≥7 (44%) tumours than AA (8%) and CA men (0%; P< 0.01). On multivariate analysis, controlling for stage, grade, PSA level and margins, AA and AC race were independent predictors of BCR. AA and AC men had significantly lower 5-year BCR-free survival (76 and 74%, respectively) than CA men (98% [P < 0.001]). This international comparison of clinicopathological outcomes in AA, AC and CA men undergoing RP shows that AA and AC men present similarly with more aggressive disease features than CA men and have lower 5-year BCR-free survival. Both AA and AC race are significant predictors of BCR, independently of stage, grade, PSA level and margin status. Further research is needed to elucidate and correct the mechanisms behind the observed difference in outcome among these populations.

Race- and Gender-Related Differences in Clinical Characteristics and Quality of Life Among Outpatients with Psychotic Disorders

Historically, the literature suggests that African Americans with mental illness are diagnosed with psychotic disorders at a higher rate and receive higher doses of antipsychotic medications than other racial groups. However, few studies have compared clinical characteristics and quality of life among African-American (AA) and white men and women. Thus, research is needed to examine potential race and gender differences in clinical characteristics, prescribing practices, and quality of life. This exploratory, hypothesis-generating study examined current and past diagnoses, current pharmacotherapy, failed psychotropic medications, and quality of life among 23 AA and 31 white men and women receiving outpatient treatment for psychosis. Depression and psychotic depression were common complaints in the sample, yet only a third of the patients received antidepressants. We found that AA men received an antidepressant for depression symptoms less often, received higher antipsychotic doses, and rated their overall quality of life as poorer than any other group. White men and AA women had a history of more years of mental illness and had experienced 57% and 69% more psychotropic medication failures, respectively, than AA men or white women. Quality of life scores were significantly related to years of mental illness, number of past diagnoses, and number of failed medications. Our data suggest that clinicians could significantly enhance prognostic outcomes in outpatients with psychotic disorders by routinely re-evaluating depressive symptomatology and prescribing practices and considering adding psychosocial interventions to avert deterioration in quality of life. Further investigation of race and gender differences in quality of life and satisfaction as a function of diagnoses and treatment is warranted.

Interaction among variant vascular endothelial growth factor (VEGF) and its receptor in relation to prostate cancer risk

Prostate cancer (PCa) incidence and mortality are disproportionately high among African-American (AA) men. Its detection and perhaps its disparities could be improved through the identification of genetic susceptibility biomarkers within essential biological pathways. Interactions among highly variant genes, central to angiogenesis, may modulate susceptibility for prostate cancer, as previous demonstrated. This study evaluates the interplay among three highly variant genes (i.e., IL-10, TGFbetaR-1, VEGF), their receptors and their influence on PCa within a case-control study consisting of an under-served population. This study evaluated single gene and joint modifying effects on PCa risk in a case-control study comprised of 859 AA men (193 cases and 666 controls) using TaqMan qPCR. Interaction among polymorphic IL-10, TGFbetaR-1 and VEGF was analyzed using conventional logistic regression analysis (LR) models, multi-dimensionality reduction (MDR) and interaction entropy graphs. Symbolic modeling allowed validation of gene-gene interaction findings identified by MDR. No significant single gene effects were demonstrated in relation to PCa risk. However, carriers of the VEGF 2482T allele had a threefold increase in the risk of developing aggressive PCa. The presence of VEGF 2482T combined with VEGFR IVS6 + 54 loci were highly significant for the risk of PCa based on MDR and symbolic modeling analyses. These findings were substantiated by 1,000-fold cross validation permutation testing (P = 0.04), respectively. These findings suggest the inheritance of VEGF and VEGFR IVS6 + 54 sequence variants may jointly modify PCa susceptibility through their influence on angiogenesis. Larger sub-population studies are needed to validate these findings and evaluate whether the VEGF-VEGR axis may serve as predictors of disease prognosis and ultimately clinical response to available treatment strategies.

Results from a prostate cancer admixture mapping study in African-American men.

There are considerable racial disparities in prostate cancer risk, with a 60% higher incidence rate among African-American (AA) men compared with European-American (EA) men, and a 2.4-fold higher mortality rate in AA men than in EA men. Recently, studies have implicated several African-ancestry associated prostate cancer susceptibility loci on chromosome 8q24. In the current study, we performed admixture mapping in AA men from two independent case-control studies of prostate cancer to confirm the 8q24 ancestry association and also identify other genomic regions that may harbor prostate cancer susceptibility genes. A total of 482 cases and 261 controls were genotyped for 1,509 ancestry informative markers across the genome. The mean estimated individual admixture proportions were 20% European and 80% African. The most significant observed increase in European ancestry occurred at rs2141360 on chromosome 7q31 in both the case-only (P = 0.0000035) and case-control analyses. The most significant observed increase in African ancestry across the genome occurred at a locus on chromosome 5q35 identified by SNPs rs7729084 (case-only analysis P = 0.002), and rs12474977 (case-control analysis P = 0.004), which are separated by 646 kb and were adjacent to one another on the panel. On chromosome 8, rs4367565 was associated with the greatest excess African ancestry in both the case-only and case-control analyses (case-only and case-control P = 0.02), confirming previously reported African-ancestry associations with chromosome 8q24. In conclusion, we confirmed ancestry associations on 8q24, and identified additional ancestry-associated regions potentially harboring prostate cancer susceptibility loci.

Prostate cancer screening and shared decision‐making preferences among African‐American members of the Prince Hall Masons

Shared decision making (SDM) is recommended as one method to assist men in making an informed decision about prostate cancer screening (PCS). SDM preferences for PCS have not been evaluated among African-American (AA) men. Given AA men's increased risk and the uncertainty surrounding screening, it is critical to determine how to assist AA men in making an informed decision. We assessed the extent to which a sample of AA men wished to engage in SDM regarding PCS and the demographic and psychological characteristics associated with SDM preferences. Participants completed a telephone interview that covered demographic and medical information, SDM preferences, PCS knowledge, decisional conflict, and satisfaction with previous screening decisions. Subjects included 286 AA men aged 40-70, who were members of a Masonic organization. Fifty-seven percent preferred SDM, 36% preferred to make their own decision, and 7% wanted their doctor to decide. A higher level of education and older age were associated with preferring SDM (p<0.05), while men with greater PCS knowledge were more likely to prefer to make the decision independently (p<0.05). Results suggest that physicians need to be prepared to discuss PCS with their patients. Further, more attention may be needed to engage younger, less educated, and less knowledgeable men as they may be less likely to discuss PCS. This understanding of AA men's preferences for PCS decisions helps to clarify the issues that health professionals need to consider when attempting to assist AA men in making a PCS decision.

Family risk score of coronary heart disease (CHD) as a predictor of CHD: the Atherosclerosis Risk in Communities (ARIC) study and the NHLBI family heart study.

Family history of coronary heart disease (CHD) has been found to be a risk factor for CHD in numerous studies. Few studies have addressed whether a quantitative measure of family history of CHD (family risk score, FRS) predicts CHD in African Americans. This study assessed the association between FRS and incident CHD of participants, and the variation of the association by gender and race. Participants in the study were a biracial population-based cohort with 3,958 African Americans and 10,580 Whites aged 45-64 years old in the ARIC baseline survey (1987-1989). They were randomly selected from four U. S. communities. During follow-up (1987-1993), 352 participants experienced the onset of CHD. Incidence density of CHD (per 1,000 person-years) was 7.8 and 3.6 among African-American men (AAM) and women (AAW), and 7.2 and 2.2 among White men (WM) and women (WW). The hazard rate ratio (HRR) of CHD associated with one standard deviation increase of FRS was 1.52 in AAW, 1.46 in AAM, 1.41 in WW, and 1.68 in WM. The HRRs decreased 4.6% in AAW, 1.4% in WW, 5.7% in AAM, and 3.0% in WM, but increased 2.1% in AAM after adjustment for selected covariates. FRS predicts incident CHD in African Americans and Whites, men and women. The relation of FRS to incident CHD can be only partially explained by the selected risk factors in the biological causal pathways: IMT, T-G, LDL, HDL, Lp(a), fibrinogen and hypertension. No significant difference by race has been found in this study.

Should African‐American men be tested for prostate carcinoma at an earlier age than white men?

BACKGROUND. There have recently been challenges to testing high risk populations, i.e., African-American men younger than 50 years, for prostate carcinoma (PCa). The mortality rate of patients with PCa between ages 40 and 60 years is nearly 3 times greater among African-American men (AAM) compared with white men (WM). The literature in support of testing AAM at an earlier age than WM is sparse. Therefore, the authors present clinical and histologic data that support the testing of AAM at a younger age, utilizing data on patients with clinically localized PCa. METHODS. Examination of consecutive radical prostatectomy specimens from AAM and WM was performed from January 1991 to June 1996 among AAM and WM at Wayne State University, Harper Hospital, Detroit, Michigan. International, salvage prostatectomy, and neoadjuvant hormonal therapy patients were excluded, as were patients with lymph node metastasis. The authors examined biochemical recurrences of PCa in this cohort of men treated from January 1991 through December 1995. Univariate analysis of contingency tables was performed, using chi-squared-tests to assess the correlation between stage and race after stratification of patients by age group. Biochemical recurrence was analyzed using the Kaplan-Meier method and the log rank test. RESULTS. The authors examined radical prostatectomy specimens from 759 patients and biochemical recurrence outcome of 655 patients. AAM patients ages 50-69 years had higher prostate specific antigen levels, worse Gleason scores, more advanced stages of disease, and a higher recurrence rate. However, among men ages70-79 years, there was no difference in these parameters between AAM and WM. Among men ages 40-49 years, a larger sample size is necessary to make meaningful comparisons. CONCLUSIONS. Data on the outcomes of men treated for clinically localized PCa demonstrated more advanced disease and more frequent recurrence among young AAM than among WM, young and of advanced age. These differences in disease severity and recurrence, in addition to the disproportionate mortality among young AAM, are strong evidence that AAM should be tested for PCa at an earlier age than WM.

Should African-American men be tested for prostate carcinoma at an earlier age than white men?

There have recently been challenges to testing high risk populations, i.e., African-American men younger than 50 years, for prostate carcinoma (PCa). The mortality rate of patients with PCa between ages 40 and 60 years is nearly 3 times greater among African-American men (AAM) compared with white men (WM). The literature in support of testing AAM at an earlier age than WM is sparse. Therefore, the authors present clinical and histologic data that support the testing of AAM at a younger age, utilizing data on patients with clinically localized PCa. Examination of consecutive radical prostatectomy specimens from AAM and WM was performed from January 1991 to June 1996 among AAM and WM at Wayne State University, Harper Hospital, Detroit, Michigan. International, salvage prostatectomy, and neoadjuvant hormonal therapy patients were excluded, as were patients with lymph node metastasis. The authors examined biochemical recurrences of PCa in this cohort of men treated from January 1991 through December 1995. Univariate analysis of contingency tables was performed, using chi-squared-tests to assess the correlation between stage and race after stratification of patients by age group. Biochemical recurrence was analyzed using the Kaplan-Meier method and the log rank test. The authors examined radical prostatectomy specimens from 759 patients and biochemical recurrence outcome of 655 patients. AAM patients ages 50-69 years had higher prostate specific antigen levels, worse Gleason scores, more advanced stages of disease, and a higher recurrence rate. However, among men ages 70-79 years, there was no difference in these parameters between AAM and WM. Among men ages 40-49 years, a larger sample size is necessary to make meaningful comparisons. Data on the outcomes of men treated for clinically localized PCa demonstrated more advanced disease and more frequent recurrence among young AAM than among WM, young and of advanced age. These differences in disease severity and recurrence, in addition to the disproportionate mortality among young AAM, are strong evidence that AAM should be tested for PCa at an earlier age than WM.

Is the ratio of transition zone to total prostate volume higher in African-American men than in their Caucasian or Hispanic counterparts?

To determine if the transition zone index (TZI, the ratio between transition zone volume, TZV, and total prostate volume, as estimated by transrectal ultrasonography, TRUS) differs among African-American (AA), Hispanic and Caucasian men. The study group consisted of 104 age-matched men (36 AA, 34 Hispanic and 34 Caucasian) with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). A control group of 55 age-matched men, equally distributed among the three ethnic groups, but with no BPH (based on a digital rectal examination) were also evaluated. All men completed the International Prostate Symptom Score (IPSS) and a measurement of peak urinary flow rate (Qmax), prostate volume and TZV (by TRUS) and the TZI calculated. In the control group, the mean prostate volume was 20.9, 18.2 and 19.8 mL, the TZV 6.9, 4.9, and 5.4 mL and the TZI 0.33, 0.27 and 0.25 for AA, Hispanic and Caucasian men, respectively. The TZI was significantly higher in AA than in either Hispanic or Caucasian men (P < 0.03). Although there were no differences in prostate volume among the three ethnic groups with BPH, the mean (SD) TZV and TZI were significantly higher in AA men than in either their Hispanic or Caucasian counterparts, at 15.8 (7.6) mL and 0.43, 12.7 (8.1) mL and 0.37, and 13.8 (6.7) mL and 0.37, respectively. For all groups, age correlated with the IPSS (r = 0.22, P < 0.04); the mean (SD) IPSS was 14.3 (5.7), 10.2 (2.9) and 10.6 (4.9) for AA, Hispanic and Caucasian men, respectively. There was no correlation between the IPSS and either prostate volume or TZV, but there was a strong correlation with the TZI (r = 0.29, P < 0.01), regardless of race. These results suggest that AA men have a greater TZV and a higher TZI than their Caucasian or Hispanic counterparts, regardless of the presence of lower urinary tract symptoms. Studies are underway to determine if these differences are clinically significant and correlate with either subjective and/or objective parameters of BPH.