High Incidence Of Prostate Cancer Research Articles

Genetic variability of the fatty acid synthase pathway is not associated with prostate cancer risk in the European Prospective Investigation on Cancer (EPIC)

A western lifestyle, characterised by low rates of energy expenditure and a high-energy diet rich in animal protein, saturated fats and refined carbohydrates, is associated with high incidence of prostate cancer in men. A high-energy nutritional status results in insulin/IGF signalling in cells, which in turn stimulates synthesis of fatty acids. We investigated whether the genetic variability of the genes belonging to the fatty acid synthesis pathway is related to prostate cancer risk in 815 prostate cancer cases and 1266 controls from the European Prospective Investigation on Cancer (EPIC). Using a tagging approach and selecting 252 SNPs in 22 genes, we covered all the common genetic variation of this pathway. None of the SNPs reached statistical significance after adjusting for multiple comparisons. Common SNPs in the fatty acid synthase pathway are not major contributors to prostate cancer risk.

Abstract PR-8: Gene-environment interactions between JAZF1 and occupational and neighborhood lead exposure in African American prostate cancer cases

Abstract African American men have the highest incidence of prostate cancer in the world and have substantially higher rates of prostate cancer when compared to white men in the U.S. The cause(s) for this race disparity remains elusive. A single nucleotide polymorphism (SNP), rs10486567, in intron 2 of juxtaposed with another zinc finger protein 1 (JAZF1) has been associated with increased risk of prostate cancer in genome-wide association studies (GWAS) and may be key to uncovering reasons for disparities in the disease. JAZF1 is a cysteine-hystidine structured zinc finger protein, a type of protein that has been shown to interact with lead in vitro. Lead is recognized as a probable carcinogen in humans and African American men who are residentially segregated to industrialized urban environments in the U.S. have higher blood lead levels on average compared to white men. In a case-only study of 228 African American men with prostate cancer diagnosed at a large health system in the Detroit Metropolitan area, we assessed gene-environment interactions (GxE) between rs10486567 (CC vs. CT/TT genotype) and two sources of lead exposure. Lifetime occupational lead exposure was determined through industrial hygiene review of extensive face-to-face interviews. Neighborhood lead exposure, defined as the median proportion of census tract housing built before 1950 (≥ 47% vs. <47%), was derived from subjects address at time of diagnosis. Generalized estimating equation (GEE) modeling was used for analyses that included nested census data. In younger African American cases (<62 years of age), we found a significant gene-environment interaction between rs10486567 CC carriers and high occupational-respiratory lead exposure when compared to those with no respiratory lead exposure (OR 2.68, CI 1.05-6.88, p=.04). A significant GxE interaction was also observed between CC carriers and residence in a neighborhood with a large proportion of older housing in all cases and younger cases (all OR 1.92, CI 1.12-3.29, p=.017, younger OR 2.64, CI 1.21-5.73, p=.014, older OR 1.64, CI 0.73-3.70, p=.23). The interaction between rs10486567 and housing remained significant even after adjustment for occupational lead exposure. Combining lead exposure from occupation and neighborhood housing into a four category index showed even stronger interactions between the polymorphism and the highest lead exposed group compared to the lowest exposure group (all OR 3.13, CI 1.22-7.99, p=.017). These findings indicate that lead may be an important risk factor for prostate cancer in carriers of the rs10486567 CC genotype. Future studies of race disparities in prostate cancer should further assess interactions between lead and JAZF1 and lead and other zinc containing proteins. Focusing on genes and polymorphisms identified in GWAS studies might help to identify environmental risk factors for prostate cancer. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):PR-8.

Abstract A71: Perceived stress management skills and quality of life in ethnic minority men newly diagnosed with prostate cancer

Abstract Ethnic group differences exist in the diagnosis and treatment outcomes of prostate cancer (PC). African American men have the highest PC incidence, are more likely to be diagnosed at an advanced stage, and are twice as likely to die of PC than are Non-Hispanic White men. Previous research has shown ethnic minority men report poorer general and health-related quality of life (QOL) prior to initiating PC-related treatment. However, little is known about psychosocial factors associated with pre-treatment levels of QOL. This study examined the relationship between perceived stress management skills (PSMS) and QOL in men recently diagnosed with PC who had not initiated treatment. Sixty-two men completed a baseline assessment prior to initiating PC-related treatment. Participants’ mean age was 61.77 (SD= 6.39) and had been diagnosed within the past 3 months. All were ethnic minorities (53% Hispanic and 47% African American/Black). Measures included the Measure of Current Status, the Functional Assessment of Cancer Therapy, and the Expanded Prostate Cancer Index Composite to assess PSMS, general QOL, and disease-specific QOL, respectively. Several hierarchical regression models were tested to examine whether PSMS were positively related to QOL at baseline, controlling for relevant covariates (e.g., age and ethnicity). Results indicated that PSMS associated with better general and disease specific QOL and accounted for a significant amount of the variance (i.e., 14 to 20%) in several functioning and QOL domains (i.e., urinary functioning [R1,58)= 4.55, p<.04, β=.261], urinary incontinence [F(1,58)= 8.95, p<.01, β=.367], social/family well-being [R1,58)= 10.20, p<.01, β=.394], functional well-being [R1,58)= 8.08, p<.01, β=.355], and total well-being [F(1,58)= 13.75, p<.01, β=.447]. Results suggest that among ethnic minorities, greater perceived ability to manage stress at diagnosis is associated with several indices of QOL. Future studies should investigate the extent to which PSMS may impact adjustment and recovery following treatment and whether psychosocial interventions targeting such skills are effective in improving QOL in this population. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A71.

Factors influencing prostate cancer screening in African American men.

African American men have the highest prostate cancer incidence and mortality rates worldwide, but have lower screening rates compared with Caucasian men. The purpose of the study was to identify social ecological factors that affect screening behaviors in African American men, knowledge that could be integral to the design of culturally appropriate interventions. The exploratory study included 60 African American males recruited from the greater Detroit metropolitan area. Social ecological variables examined included age, marital status, presence of health insurance, education, health values and behaviors, physician trust, and perceived stress coping (John Henryism). Analyses included descriptives, chi-square tests, one-way ANOVAs, and logistic regression. Findings concluded that a parsimonious model consisting of two variables (age and health values) was predictive. African American males, > or =50 years, with higher positive health values were more likely to obtain screening. Findings imply the importance of health values and targeted educational and screening interventions for younger African American men.

Prostate cancer incidence, stage at diagnosis, treatment and survival in ethnic groups in South‐East England

To use self-assigned ethnicity to examine patterns of incidence, stage, treatment and survival in patients with prostate cancer in South-east England. Data on 36 961 men resident in South-east England and diagnosed with prostate cancer between 1998 and 2003 were extracted from the Thames Cancer Registry. Ethnicity information was obtained from the Hospital Episode Statistics dataset, and matched to the cancer records. The ethnic groups examined were White (19 688), Black (1422) and Indian/Pakistani (397). Age-standardized incidence rate ratios were calculated overall and for narrower age groups, with White men as the baseline group. Logistic regression was used to assess whether patients had a stage of disease recorded at diagnosis, if so whether it was metastatic, and to examine treatment received. To assess overall and prostate cancer-specific survival (PCSS), Cox regression models were fitted, adjusting sequentially for age, socioeconomic status, treatment received and stage of disease at diagnosis. Indian/Pakistani men had a lower age-standardized rate than White men (rate ratio 0.69, 95% confidence interval 0.63-0.75), while Black men had a higher rate ratio (2.51, 2.30-2.73). There was no difference in the proportion of men diagnosed with metastatic disease in each ethnic group. There was variation in recorded surgery and hormone treatment. Indian/Pakistani men had better PCSS than White men (fully adjusted hazard ratio 0.76, P = 0.024). There was no difference in PCSS between Black and White men (hazard ratio 0.93, P = 0.238). Black men had the highest incidence of prostate cancer, followed by White, then Indian/Pakistani men. The relative excess of prostate cancer in Black vs White men was strongly age-dependent. Despite differences in recorded treatment, Indian/Pakistani men had better overall survival and PCSS. Black men also had better overall survival, and their PCSS was similar to that of White men. This might be due to access to the publicly funded National Health Service in the UK.

Design and In vitro Evaluation of Branched Peptide Conjugates: Turning Nonspecific Cytotoxic Drugs into Tumor‐Selective Agents

The use of peptide receptors as targets for tumor-selective therapies was envisaged years ago with the findings that receptors for different endogenous regulatory peptides are overexpressed in several primary and metastatic human tumors, and can be used as tumor antigens. Branched peptides can retain or even increase, through multivalent binding, the biological activity of a peptide and are very resistant to proteolysis, thus having a markedly higher in vivo activity compared with the corresponding monomeric peptides. Oligo-branched peptides, containing the human regulatory peptide neurotensin (NT) sequence, have been used as tumor-specific targeting agents. These peptides are able to selectively and specifically deliver effector units, for cell imaging or killing, to tumor cells that overexpress NT receptors. Results obtained with branched NT conjugated to different functional units for tumor imaging and therapy indicate that branched peptides are promising novel multifunctional targeting molecules. This study is focused on the role of the releasing pattern of drug-conjugated branched NT peptides. We present results obtained with oligo-branched neurotensin peptides conjugated to 6-mercaptopurin (6-MP), combretastain A-4 (CA4) and monastrol (MON). Drugs were conjugated to oligo-branched neurotensin through different linkers, and the mode-of-release, together with cytotoxicity, was studied in different human cancer cell lines. The results show that branched peptides are very promising pharmacodelivery options. Among our drug-armed branched peptides, NT4-CA4 was identified as a candidate for further development and evaluation in preclinical pharmacokinetic and pharmacodynamic studies. This peptide-drug exhibits significant activity against pancreas and prostate human cancer cells. Consequently, this derivative is of considerable interest due to the high mortality rates of pancreas neuroendocrine tumors and the high incidence of prostate cancer.

Dietary patterns and risk of advanced prostate cancer: a principal component analysis in Uruguay

In order to explore the role of broader eating patterns in the etiology of prostate cancer, we conducted a principal components analysis among Uruguayan men. The study included 345 newly diagnosed cases of advanced prostate cancer and 690 hospitalized controls. The factor analysis was performed using the control population. Factor analysis allowed the extraction of five patterns, labeled as prudent, traditional, substituter, drinker, and Western. Whereas the traditional and Western patterns were directly associated with risk of prostate cancer (OR for high quartile versus the low quartile of the Western diet was 2.35, 95% CI 1.44-3.85, p-value for trend < 0.0001), the prudent, drinker, and substituter patterns were not associated with risk of the disease. After adjustment of each pattern for the foods with high loadings, these three patterns did not modify substantially their original ORs. The Western and traditional patterns could partially explain the high incidence of advanced prostate cancer in Uruguay, a main producer of beef in the World.

Abstract A146: Meloxicam inhibits prostate tumor growth and progression in prostate specific-PTEN conditional gene targeting knockout mice

Abstract A high incidence of prostate cancer in older men suggests that agents that inhibit or delay the disease process could be beneficial in reducing cancer mortality and morbidity. Increased expression of COX-2 has been found in most of the cancers and compelling evidence from genetic and clinical studies indicates that COX-2 upregulation is one of the key steps in carcinogenesis. There is a strong body of evidence pointing out the role of COX-2 early in the prostate carcinogenesis process, particularly in the progression of prostatic intraepithelial neoplasia (PIN) lesions to prostate carcinoma. Epidemiological data suggests that treatments with non-steroidal anti-inflammatory drugs (NSAIDs) were associated with reduced risk in a number of malignancies. We evaluated the chemopreventive efficacy of meloxicam, a selective COX-2 inhibitor, against prostate cancer in prostate-specific PTEN knockout mice. In our mouse model, homozygous inactivation of PTEN leads to PIN at 8 weeks of age with 50% of the mice progressing to prostate cancer by the age of 10 weeks and 100% by 20 weeks of age. Mice were fed meloxicam (3.0 mg/l ad libitum) in drinking water beginning at 4 or 11 weeks of age for 5 to 28 weeks in stage-specific manners. There were no bodyweight differences were seen between treatment groups. Our data showed a significant reduction (19–23%, p&amp;lt;0.05) of genitourinary tract weights in meloxicam-fed mice. There was a strong reduction in the incidence and extent of adenocarcinoma and increases in PIN in meloxicam-fed mice. Significant differences in tumor differentiation scores were also noted in the treatment groups (p&amp;lt;0.05). Immunohistochemical analysis revealed that meloxicam treatment did in fact reduce COX-2 expression without inhibiting COX-1. Furthermore, meloxicam-fed mice also showed reduced proliferation rates as well as increases in apoptotic rates. Moreover, a reduction of VEGF expression in tumors and tumor stroma was also observed in mice treated with meloxicam. These results suggest that meloxicam safely inhibited tumor growth and progression in the PTEN knockout mouse model by antiproliferative, pro-apoptotic and anti-angiogenic effects and may thus be a suitable candidate for use in human chemoprevention trials. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A146.

An overview of the diagnosis and management of prostate cancer in Nigeria: Experience from a north-central state of Nigeria

Prostate cancer was previously perceived to be low in Africa. Recent studies have shown that Africa has a high prevalence up to 300 per 100,000. This is close to that found among African Americans who have the highest incidence of prostate cancer in the world. In many African countries, prostate cancer is the leading cause of cancer among men. In many cases, it is closely following or even leading HIV related cancers such as cancer of the eye and Kaposi Sarcoma. The current article highlights this high incidence and several other elements related to its prevention, diagnosis and management which are peculiar to Africa, to such an extent that it is almost a different disease than that seen in developed countries.

Barbers as Lay Health Advocates— Developing a Prostate Cancer Curriculum

Purpose:The purpose of this study was to develop and test the efficacy of a prostate health curriculum designed to train African American and Afro Caribbean barbers to deliver prostate cancer control messages to their customers. Procedures:The curriculum was drafted from information obtained from needs assessment surveys administered to barbers and customers from various barbershops in Brooklyn, New York. Focus groups were conducted to further inform the curriculum, which was pilot tested in training sessions. Findings:The high incidence of late-stage diagnosis prostate cancer in African Americans has often been attributed to lack of screening. In surveys administered to 92 customers and 19 barbers, only 26% of customers and 42% of barbers reported having some knowledge of the prostate-specific antigen (PSA) screening test. More than 90% of the barbers expressed a willingness to obtain prostate cancer information to specifically share with their customers, and 83% of customers expressed an interest in obtaining prostate cancer information and willingness to receive that information from their barbers. Following the pilot training, barber knowledge of prostate cancer increased significantly (p < .0001). Conclusions:This pilot study suggests that there is a need for intervention programs that will raise awareness and increase prostate health knowledge and behavior in communities with elevated incidence of prostate cancer. The study further suggests that barbers are willing to use their leadership skills to educate and encourage their customers to engage in informed decision making.

Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines

Prostate specific antigen (PSA) testing is associated with increased prostate cancer (PCa) incidence. Ireland has no national guidelines on PCa screening and had the highest PCa incidence in Europe, 2006. To investigate trends in PSA testing in Ireland. Data on PSA tests, 1994-2005, was collated. Age-standardised rates of PSA testing increased 39 and 25% annually in men <50 and >or=50 years, respectively. Most tests were performed in men 50-69 years; 26 and 22% were performed in men <50 and >or=70 years, respectively. Baseline PSA tests peaked in 2004, at 16% of men. 83% of baseline tests were <4.0 ng/ml. Repeat testing increased with age and PSA level (P < 0.001); men <50 years and with levels <4.0 ng/ml had >1 tests in <21 months. PCa incidence increased 9% annually, 1994-2005. Uptake of PSA testing was rapid: increased use was simultaneous with increased PCa incidence. National guidelines are needed to manage this important public health issue.

The association between MIF‐173 G&gt;C polymorphism and prostate cancer in southern Chinese

Accumulating epidemiological and molecular evidence suggests that inflammation is an important component in the etiology of PCa. Macrophage migration inhibitory factor (MIF) plays an important role in the pro- and anti-inflammatory response to infection. This study is aimed at investigating the potential association between MIF-173 G>C polymorphism, Gleason score, clinical stage, and prostate-specific antigen (PSA) value with respect to PCa incidence among the Han nationality in Southern China. Genotyping was performed by using tetraprimer polymerase chain reaction (PCR) on 259 PCa patients and 301 cancer-free controls. We found that the MIF-173*C variant allele was significantly associated with an increased risk of PCa [adjusted odd ratio (OR) = 2.99, 95% confident interval (CI): 1.94-4.60] and higher Gleason scores from the PCa subjects (adjusted OR = 10.72, 95% CI: 5.35-21.49). In addition, we noted that the MIF -173*C variant allele was related to higher clinical stages and PSA values in PCa patients (adjusted OR = 15.68, 95% CI: 7.40-33.23; adjusted OR = 4.37, 95% CI: 2.41-7.92, respectively). Our data suggest that MIF-173 polymorphisms may be associated with a higher incidence of prostate cancer compared to controls, and appears to be associated with higher Gleason scores, higher clinical stages, and PSA values in those with prostate cancer.

Tomato Product Adherence Dynamics in African‐American Men at Risk for Prostate Cancer

African‐American (AA) men have the highest incidence of prostate cancer (PC) and tomato product (TP) intake is associated with reduced risk. Can AA men significantly increase self‐selected TP intake through diet counseling alone? AA men with PSA ≥ 2.5 ng/mL were randomized to either increase TP intake (intervention group (IG), N = 22) through weekly telephone calls, or to a control group (CG, N=14) receiving no TP coaching over 3 months. Mean dietary lycopene intake was 24.6 ± 27.1 and 5.8 ± 9.6 mg/d, respectively for IG and CG (p = 0.04). The IG consumed a mean of 7.1 TP servings/wk and CG only 3.5 (p = 0.005). The IG increased plasma lycopene level by 53% and 40%, at 1 and 3 months (p = 0.001, p = 0.003, respectively), while there was no increase in the CG. Subjects with high baseline leukocyte DNA damage had significantly less damage after 3 months (22.8%). Incentives/impediments to TP intake were assessed weekly in the IG. Incentives in order of frequency were (1) in study, (2) likability, (3) mass media, (4) social support. Impediments were (1) forgot, (2) run out, (3) hospitalization/sick, (4) tight budget. AA men at risk for PC were able and willing to increase TP intake sufficiently to raise plasma lycopene levels and decrease DNA damage over 3 months. Self‐selected whole food interventions through diet counseling alone may be a feasible approach for efficacy studies.Support: Roybal Center Health Promotion, UIC

Comparing Dietary and Other Lifestyle Factors Among Immigrant Nigerian Men Living in the US and Indigenous Men from Nigeria: Potential Implications for Prostate Cancer Risk Reduction

Although African men may share a common genetic predisposition contributing to the higher incidence of prostate cancer (CaP), the etiology of the variability in risk observed even among African men living in varying environments and cultures, highlights the strong and evolving research regarding the contribution of behavioral factors that may modify these biological risk factors. Our aim was to recruit Nigerian men from West Africa who had migrated and currently living in the US and indigenous men living in Nigeria to evaluate and compare differences in behavioral variables that are implicated to in contribute to CaP mortality and morbidity. Using a cross-sectional study design, we recruited participants between age 35 and 70 during a CaP screening event in Abeokuta (Nigeria) and Houston (US). Data were collected using standard questionnaires and subject interviews on factors such as smoking, dietary intake, intake of traditional and non-traditional supplements, physical activity and alcohol consumption. Descriptive analyses were used to characterize the demographic characteristics of the study participants. Sample t-test analyses were then used to compare the behavioral variables of the migrant and indigenous men from Nigeria. Immigrant men from Nigeria had significantly higher fruit and whole grain intake, higher number of hours of purposeful physical activity and significantly lower tobacco use and intake of trans fats in their diet compared to their indigenous counterparts which may potentially contribute to decreased CaP risk in this cohort. However, greater intake of meats, oils, alcohol and reduction in fish intake may contribute to greater risk, although the proportion of risk reduction or risk increase is difficult to estimate in this sample size. Factors associated to acculturation, the relative accessibility and the affordability may contribute to the choices made by immigrant Nigerian men compared to their indigenous counterparts. Although these results are provocative and significant, future well powered studies controlling for variability in population sampling should validate these observations.

Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa

BackgroundAfrican American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade.ResultsSeveral published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks.ConclusionThe growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.

Surgical versus medical castration in the Bahamas: a male macho paradox

Background The high prevalence and incidence of prostate cancer is a global phenomenon [1,2]. In the pre-Prostate Specific Antigen (PSA) era, the clinical hallmarks of prostate cancer were late disease presentations and high mortality rates [3]. The documentation of even more advanced presentations and higher mortality rates in males of African ancestry is of great concern for countries like the Bahamas with significant populations of this ethnicity. [4-10]

Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Prostate cancer is a major public health burden throughout the world. The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and the slow natural progression and biological heterogeneity of the disease, has made its management a complex and controversial issue. There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits. There are a number of clinical parameters and clinical nomograms to help with the choice of treatment. Magnetic resonance imaging (MRI) is a technique which makes safer, more individualized therapies possible due to high spatial resolution, superior contrast resolution, multiplanar capability, and a large field of view. Other MRI techniques such as MR spectroscopic imaging, dynamic contrast-enhanced MRI or perfusion MRI, and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry, Brownian motion of water molecules, and capillary wall permeability, respectively. This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, some future prospects for MRI in prostate cancer management are given.

African American Men and Self-Efficacy in Preventing Prostate Cancer

African American men in the U.S. have a higher incidence of prostate cancer compared to white American men. When diagnosed with prostate cancer, African American men are noted to experience a much ...

Prostate Cancer Cognitive-Behavioral Factors in a West African Population

Similar to African American men, several published studies indicate high incidence of prostate cancer among Nigerian men. However, there is no published study on personal factors that influence prostate cancer detection in this population. We explored prostate cognitive-behavioral factors among indigenous Nigerian men and Nigerian immigrants residing in the US. A cross-sectional survey methodology was employed to collect data from Nigerian men residing in Abeokuta (Nigeria) and Houston (US). Study participants were men between 35 and 79 years. The demographic characteristics of both study groups were similar. Based on two-sample comparison results, indigenous Nigerian men demonstrated significant differences from US Nigerian men on several prostate cancer personal cognitive-behavioral factors, including perceived susceptibility to prostate cancer, attitude towards prostate cancer screening and prostate cancer knowledge. Emigration of Nigerian men from Nigeria to the US has a significant impact on prostate cancer knowledge and beliefs.

Barriers to the Initiation and Maintenance of Prostate Specific Antigen Screening in Black American and Afro-Caribbean Men

Black American and Afro-Caribbean men may experience the highest incidence of prostate cancer globally. We examined the effect of race/ethnicity on the initiation and maintenance of annual prostate specific antigen screening and the role of physicians in screening continuity in these high risk groups. Stratified cluster sampling of census tract blocks in Brooklyn, New York yielded 533 male participants 45 to 70 years old. The men were classified into 4 racial/ethnic groups, including white men born in the United States, black men born in the United States, immigrant Jamaican men, and immigrant men from Trinidad and Tobago. Participants recorded the number of prostate specific antigen tests performed in the last 10 years. Subject adherence was calculated as annually screened, less than annually screened and never screened. Multinomial logistic regression was used to compare screening behavior across the ethnic groups. Overall 28.3% of participants reported annual screening, 44.5% reported screening less than annually and 27.2% reported having never been screened. Jamaicans (OR 3.1) and men from Trinidad and Tobago (OR 5.4) were more likely to screen less than annually compared to not at all. However, black American men (OR 0.3), Jamaican men (OR 0.3), and men from Trinidad and Tobago (OR 0.2) were less likely to maintain annual screening compared with white men, as were men who did not undergo an annual physical examination (OR 0.3) and those with low prostate cancer knowledge (0.5). Afro-Caribbean men are not less likely than white men to undergo initial prostate specific antigen screening but they are much less likely to maintain annual screening. Through comprehensive discussion and annual examinations physicians have an important role in ensuring prostate specific antigen screening continuity. Our results suggest the need for more culturally appropriate outreach efforts and educational interventions to improve screening compliance.