Higher Rates Of Prostate Cancer Research Articles

Adaptation of the socioecological model to address disparities in engagement of Black men in prostate cancer genetic testing

BackgroundBlack men consistently have higher rates of prostate cancer (PCA)- related mortality. Advances in PCA treatment, screening, and hereditary cancer assessment center around germline testing (GT). Of concern is the significant under-engagement of Black males in PCA GT, limiting the benefit of precision therapy and tailored cancer screening despite longstanding awareness of these disparities. To address these critical disparities, the Socioecological Model (SEM) was employed to develop comprehensive recommendations to overcome barriers and implement equitable strategies to engage Black males in PCA GT.MethodsClinical/research experts, national organization leaders, and community stakeholders spanning multiple regions in US and Africa participated in developing a framework for equity in PCA GT grounded in the SEM. A novel mixed-methods approach was employed to generate key areas to be addressed and informed statements for consensus consideration utilizing the modified Delphi model. Statements achieving strong consensus (> =75% agreement) were included in final equity frameworks addressing clinical/community engagement and research engagement.ResultsAll societal levels of the SEM (interpersonal, institutional, community, and policy/advocacy) must deliver information about PCA GT to Black males that address benefits/limitations, clinical impact, hereditary cancer implications, with acknowledgment of mistrust (mean scores [MS] 4.57-5.00). Interpersonal strategies for information delivery included engagement of family/friends/peers/Black role models to improve education/awareness and overcome mistrust (MS 4.65-5.00). Institutional strategies included diversifying clinical, research, and educational programs and integrating community liaisons into healthcare institutions (MS 4.57-5.00). Community strategies included partnerships with healthcare institutions and visibility of healthcare providers/researchers at community events (MS 4.65–4.91). Policy/advocacy included improving partnerships between advocacy and healthcare/community organizations while protecting patient benefits (MS 4.57-5.00). Media strategies were endorsed for the first time at every level (MS 4.56-5.00).ConclusionThe SEM-based equity frameworks proposed provide the first multidisciplinary strategies dedicated to increase engagement of Black males in PCA GT, which are critical to reduce disparities in PCA-mortality through informing tailored screening, targeted therapy, and cascade testing in families.

Exploring health disparities in prostate cancer through circulating tumor DNA analysis.

1603 Background: African American men (AAM) suffer from the highest rates of prostate cancer in the world. In addition, AAM experience the highest rates of aggressive prostate cancer and prostate cancer-specific mortality of any ethnic group in the United States [1, 2]. The reasons behind the increased burden of prostate cancer poor outcomes in AAM remain unresolved. A large proportion of variation in prostate cancer mortality remains unexplained solely by epidemiologic risk factors. We investigated genomic differences between AAM and Caucasian men with metastatic castration resistant prostate cancer (mCRPC) utilizing circulating tumor DNA (ctDNA) analysis. Methods: AAM and Caucasian men with mCRPC were enrolled in this study. We collected and analyzed 88 plasma samples, including 66 from Caucasian and 22 from African American patients, with no significant age difference between the groups. The targeted sequencing libraries were prepared following the Agilent SureSelect XT HS2 target enrichment workflow coupled with the SureSelect custom prostate cancer panel (Agilent, Inc.). The final libraries were sequenced on an Illumina NextSeq 2000 to generate 150 bp paired-end reads. Results: A total of 88 men with mCRPC were enrolled. About 60% of African American patients exhibited organ metastasis at the time of diagnosis, while this proportion was 36% for Caucasian patients and they primarily reported metastasis during relapse. Analyzing 1824 variants in 138 genes meeting inclusion criteria, 281 significant mutations across 88 genes revealed racial differences. Notably, 29% of these variants were somatic. Approximately 60 cancer-related pathways, tissues, and diseases were identified from these datasets, encompassing 59 of our significant genes. Among these associated genes, the prevalence of significant variants, higher in AAM, exceeds that in Caucasians in 76% of cases. The top genes that have more contribution in considering pathways are shown (Table). Conclusions: Genomic variations were observed in ctDNA analysis between African American and Caucasian patients diagnosed with metastatic castration-resistant prostate cancer. Our findings highlight the potential inclusion of ctDNA analysis in the clinical assessment of these patients, offering valuable insights for informed therapeutic decision-making. The top genes with the most contribution to prostate-related pathways. [Table: see text]

Health Burdens and SES in Alabama: Using Geographic Information System to Examine Prostate Cancer Health Disparity.

Simple SummaryThe focus of the research was to examine the relationship between Socioeconomic status and prostate cancer in Alabama’s Black Belt region. The cancer rate in Alabama is high, and the state has one of the highest rates of prostate cancer in the USA. The research aims to identify probable reasons, raise awareness, and propose cancer prevention policies. The Geographic Information System, a robust technology, has been adopted to understand Alabama’s county-level prostate cancer incidence and mortality and its association with socioeconomic and health disparities. The analysis indicated an apparent socioeconomic disparity between the Black Belt and Non-Black Belt counties of Alabama. The poverty rate is higher in Black Belt counties. The data revealed that the preexisting condition of diabetes and obesity is closely associated with prostate cancer. Also, incidence and mortality disparities strongly relate to socioeconomic status, and the preexisting condition of obesity and diabetes adds to prostate cancer incidences. Poverty is the root course of inequalities in education, income, and healthcare facilities, particularly among African Americans, contributing to Alabama’s health burden of prostate cancer. The study proposes effective health policy intervention to prevent and reduce prostate cases and mortality among underserved communities in Alabama.Socioeconomic disparities influence the risk of many diseases, including cancer. The cancer rate in Alabama is high, and the state has one of the highest rates of prostate cancer in the USA. Alabama’s counties are embedded with socioeconomic disparities, politics, race, ethnicity, and oppression, among which social equity and socioeconomic status (SES) been closely associated with prostate cancer. The Geographic Information System (GIS) has become a valuable technology in understanding public health in many applications, including cancer. This study integrates Alabama’s county-level prostate cancer incidence and mortality and its association with socioeconomic and health disparities. We conducted robust data mining from several data sources such as the Alabama State Cancer Profile data, Alabama Department of Health, American Cancer Society, Center for Disease Control, and National Cancer Institute. The research method is the Geographic Information System (GIS), and we employed prostate cancer data within GIS to understand Alabama’s prostate cancer prevalence regarding SES. The GIS analysis indicated an apparent socioeconomic disparity between the Black Belt and Non-Black Belt counties of Alabama. The Black Belt counties’ poverty rate is also remarkably higher than non-Black Belt counties. In addition, we analyzed the median household income by race. Our analysis demonstrates that the Asian background population in the state earned the highest median income compared to non-Hispanic whites and the African American population. Furthermore, the data revealed that the preexisting condition of diabetes and obesity is closely associated with prostate cancer. The GIS analysis suggests that prostate cancer incidence and mortality disparities are strongly related to SES. In addition, the preexisting condition of obesity and diabetes adds to prostate cancer incidences. Poverty also reflects inequalities in education, income, and healthcare facilities, particularly among African Americans, contributing to Alabama’s health burden of prostate cancer.

Abstract 20: Cancer incidence in the U.S. military: An updated analysis

Abstract Background: Active duty military service members and the general US population differ in several ways related to cancer occurrence. This study aimed to update and expand our previous study which compared incidence of six cancers between the U.S. military and general populations. Methods: Cancers included in this study were pathologically confirmed malignant lung, colorectal, testicular, prostate, cervical and breast tumors diagnosed 1990-2013. The study populations were men and women aged 20-59 in the US active duty military and the population in nine areas covered by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer registry program. Military data were from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and Defense Manpower Data Center. Age adjusted rates in ACTUR and SEER and incidence rate ratios (IRR) and 95% confidence intervals (95% CI) comparing ACTUR to SEER were calculated. Comparisons were made by sex, race, and cancer stage. Results: Age adjusted incidence rates of colorectal cancer were significantly lower in ACTUR than SEER among White (IRR 0.78; 95% CI 0.72-0.84) and Black men (IRR 0.86; 95% CI 0.74-1.00), respectively. Lung cancer incidence was lower in ACTUR than SEER among White (IRR 0.55; 95% CI 0.49-0.62) and Black men (IRR 0.34; 95% CI 0.26-0.42) and White women (IRR 0.74; 95% CI 0.53-0.98). Whites in ACTUR had significantly lower incidence of testicular cancer (IRR 0.92; 95% CI 0.88-0.96). Lower incidence of cervical cancer in ACTUR was observed among both Whites (IRR 0.82; 95% CI 0.69-0.97) and Blacks (IRR 0.39; 95% CI 0.27-0.54). Incidence of prostate cancer was higher in ACTUR than SEER among both Whites (IRR 2.31; 95% CI 2.18-2.45) and Blacks (IRR 2.35; 95% CI 2.13-2.58). Results by tumor stage showed similar results between the ACTUR and SEER populations for regional and distant tumors, while no differences between the two were observed for localized tumors, except in the case of prostate cancer. Incidence of localized and regional prostate tumors was higher in ACTUR than SEER, while there was no significant difference in distant tumors. Conclusion: Active duty service members had lower age adjusted incidence rates of colorectal, lung, testicular, and cervical cancers, but higher rates of prostate cancer than the general US population. While these findings may result from the combined effects of many factors, the lower incidence in the military may be associated with healthier status of service members. In addition, universal health care for active duty military may lead to earlier diagnosis of some tumors, such as prostate cancer, in the military. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products or organizations does not imply endorsement by the US Government. Citation Format: Julie A. Bytnar, Katherine A. McGlynn, Craig D. Shriver, Kangmin Zhu. Cancer incidence in the U.S. military: An updated analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 20.

Abstract 3687: Implementing geospatial technology to understand the prostate cancer health burdens and socioeconomic status in Alabama

Abstract Socioeconomic status and health disparities are a significant liability for the prevalence of many diseases, including cancer. Among many contributing factors, lack of socioeconomic advancement and inequality in resource distribution is closely associated with prostate cancer occurrence. The State of Alabama has one of the highest rates of prostate cancer in the nation and the third cancer epidemic at the state level. Due to widespread disparities in infrastructure development, political willpower, equal healthcare, and education opportunity, Alabama's Black Belt region has been further divided by socioeconomic statuses among the majority (Whites) and minority (African American) populations. The purpose of this research is to recognize Alabama's health burdens and socioeconomic status using geo-spatial technology (GIS) to examine prostate cancer health disparity. GIS has become a valuable decision-making tool in understanding the public health care sectors, including prostate cancer prevalence. GIS supports assembling spatial and non-spatial data, displays the spatial distribution of health disparities, and underlines further interconnectivity of policy-related questions. This research incorporates county-level prostate cancer data using GIS and outlining the correlation between prostate cancer prevalence and socioeconomic factors to understand Alabama's cancer health disparity and equity. A combination of socioeconomic factors and state and federal-level cancer epidemic data sources underline Alabama's black belt region (predominantly African American) prostate cancer prevalence is higher than the non-black belt. The GIS analysis demonstrated that effective cancer prevention programs are needed to eliminate health disparities and enhance health equity among underserved populations of Alabama. Citation Format: Ram Alagan, Seela Aladuwaka, Rajesh Singh, Upender Manne, Manoj K. Mishra. Implementing geospatial technology to understand the prostate cancer health burdens and socioeconomic status in Alabama [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3687.

Racial Disparities in Prostate Cancer: Evaluation of Diet, Lifestyle, Family History, and Screening Patterns.

Racial disparities in prostate cancer incidence and mortality rates are considerable. We previously found in the Health Professionals Follow-up Study (HPFS) that African-American men had an 80% higher prostate cancer risk than White men. With 21 additional years of follow-up and four-fold increase in cases, we undertook a contemporary analysis of racial differences in prostate cancer incidence and mortality in HPFS. For 47,679 men, we estimated HRs and 95% confidence intervals (CI) for the association between race and risk of prostate cancer through 2016 using Cox proportional hazards regression. Multivariable models (mHR) were adjusted for lifestyle, diet, family history, and PSA screening collected on biennial questionnaires. 6,909 prostate cancer cases were diagnosed in White, 89 in African-American, and 90 in Asian-American men. African-Americans had higher prostate cancer incidence (mHR = 1.31; 95% CI, 1.06-1.62) and mortality (mHR = 1.67; 95% CI, 1.00-2.78), and lower PSA screening prevalence than White men. The excess risk was greater in the pre-PSA screening era (HR = 1.68; 95% CI, 1.14-2.48) than the PSA screening era (HR = 1.20; 95% CI, 0.93-1.56). Asian-Americans had lower prostate cancer risk (mHR = 0.74; 95% CI, 0.60-0.92), but similar risk of fatal disease compared with white men. Racial differences in prostate cancer incidence and mortality in HPFS are not fully explained by differences in lifestyle, diet, family history, or PSA screening. Additional research is necessary to address the disproportionately higher rates of prostate cancer in African-American men.

Factors associated with PSA testing in men ≥ 50 years in Ireland

Abstract Background Ireland has among the highest rates of prostate cancer in the EU, primarily due to widespread PSA screening. PSA screening is not recommended for asymptomatic men. Due to the potential for harm to the patient, and the economic and clinical repercussions for the healthcare system caused by inappropriate screening, this study aimed to investigate associations between PSA screening and sociodemographic, lifestyle, and health-related factors in men ≥50 years in Ireland. Methods A cross-sectional study was completed using data from Wave 4 of The Irish Longitudinal Study on Aging (TILDA), a nationally representative sample of community dwellers ≥ 50 years in Ireland. Participants self-reported having or not having a PSA test to screen for prostate cancer in the previous two years. Variables were entered into a multivariable logistic regression to estimate adjusted odds ratios (OR) for associations between PSA testing and the factors of interest. Results There were 2,426 male participants, with 68% reporting a PSA test in the previous two years. In adjusted analysis, older age (OR 1.78, 95%CI 1.32-2.31), third level education (OR 1.34, 95%CI 1.07-1.69) and a higher household net income (OR 2.14, 95% CI 1.52-3.02) increased the likelihood of PSA testing. Health-related factors positively associated with PSA testing screening were private health insurance (OR 1.89, 95%CI 1.52-2.35), blood pressure measurement in the previous year (OR 8.80, 95%CI 6.06-12.77) and a positive family history of cancer (OR 1.42, 95%CI 1.13-1.78). Conclusions High rates of prostate cancer screening are taking place in Ireland, despite the absence of a population-based screening programme. Men of older age, higher socioeconomic status and who demonstrate health-protective-behaviours have an increased risk of PSA screening. This subgroup of the population should be targeted to increase awareness of the potential benefits and harms of PSA testing. Key messages Rates of PSA screening remain high in Ireland, despite the absence of a population-based screening programme. Increased awareness of the potential harms and benefits of PSA screening is needed.

Promotion of prostate cancer screening equity: A quality improvement education initiative.

140 Background: Black men are disparately affected by prostate cancer (PC). They are more likely to develop PC and at an earlier age when the disease is more advanced at diagnosis. As a result, Black men are two to three times more likely to die from PC than white men. Given these disparities, experts increasingly promote screening for PC in Black men at a younger age. Methods: To inform implementation of a quality improvement education (QIE) project in three primary care practices in Maryland, a zip code analysis of the prevalence of PC was performed. Maryland practices were selected due to higher rates of PC in regions of the state and significant Black populations (Table). The QIE initiative started with a baseline practice assessment survey (including information on panel size, patient demographics, PC screening/treatment approaches, and barriers) and an analysis of current PC screening rates. Health system leaders and champions from the practice sites received training on patient-centered conversations with high-risk Black patients and concerning QIE planning. The champions developed rapid cycle improvement plans to implement increased screening using a patient-oriented online educational platform ( Dr. PSA ), as well as posters, and placards for patient education. Results: The overall national prevalence of PC in Medicare Fee-for-Service Program beneficiaries in 2018 was 2.65%. For Black beneficiaries the overall prevalence was 2.89%. Prevalence for beneficiaries in specific Maryland zip codes are detailed in Table. *Data not available; Source: NMQF Prostate Cancer Index Baseline practice assessment data revealed that patient panels ranged from 4,000 to 58,163 patients, with Black patients accounting for 50% or more of two of the practices and 25 to 50% of the third practice. Barriers to screening identified include financial issues, insurance restrictions, and lack of knowledge about PC and screening. Baseline screening rates are approximately 75%. Conclusions: Zip code prevalence analysis and baseline practice assessment data confirmed the relevance of implementing a QIE initiative in the three selected sites. Through a mixed-methods evaluation study, practice staff knowledge, attitudes, and self-reported practices will be assessed pre- and post-QIE initiative to assess impact of the initiative and determine opportunities for further improvement in PC screening practices.[Table: see text]

Health Trends among 9/11 Responders from 2011-2021: A Review of World Trade Center Health Program Statistics.

In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

Knowledge and Attitudes of Men in Bahrain Toward Prostate Cancer.

Bahrain has one of the highest rates of prostate cancer in the Middle East, when compared to neighboring countries. Therefore, a seminal study was undertaken, investigating the knowledge and attitudes of Arabic men over 50 years and older, who are in the highest risk group for prostate cancer. A secondary objective was to apply inter-professional student learning of research though the inclusion of medical and nursing students in the research team. A descriptive research design with data collection through a researcher-administered questionnaire. Study participants included 74 men, predominantly of Arabic origin. Whereas the results of this study are generally reflective of the international literature, the study also provides some new and interesting insights into the perspectives of Arabic men. The findings highlight the importance of a culturally sensitive, health awareness programme for men's health and prostate cancer in Bahrain. The study supports the important role of nurses in men's health promotion and disease prevention. An expansion in community nursing roles could facilitate the development of nursing specialist roles in the area of prostate disease prevention. An enhancement of undergraduate nursing student research learning occurs through active engagement with researchers in research projects, where students participate in preparing for research ethics approval, data collection, data analysis and writing for publication. Inter-professional learning is a very valuable experience in lowering traditional barriers between medicine and nursing.

The Impact of Intensifying Prostate Cancer Screening in Black Men: A Model-Based Analysis.

Black men in the United States have markedly higher rates of prostate cancer than the general population. National guidelines for prostate-specific antigen (PSA) screening do not provide clear guidance for this high-risk population. The purpose of this study is to estimate the benefit and harm of intensified PSA screening in Black men. Two microsimulation models of prostate cancer calibrated to incidence from the Surveillance, Epidemiology, and End Results program among Black men project the impact of different screening strategies (varying screening intervals, starting and stopping ages, and biopsy utilization following an abnormal PSA) on disease-specific mortality and overdiagnosis. Each strategy induces a mean lead time (MLT) for detected cases. A longer MLT reduces mortality according to estimates combining the US and European prostate cancer screening trials but increases overdiagnosis. Under historical population screening, Black men had similar MLT to men of all races and similar mortality reduction (range between models = 21%-24% vs 20%-24%) but a higher frequency of overdiagnosis (75-86 vs 58-60 per 1000 men). Screening Black men aged 40-84 years annually would increase both mortality reduction (29%-31%) and overdiagnosis (112-129 per 1000). Restricting screening to ages 45-69 years would still achieve substantial mortality reduction (26%-29%) with lower overdiagnosis (51-61 per 1000). Increasing biopsy utilization to 100% of abnormal tests would further reduce mortality but substantially increase overdiagnosis. Annual screening in Black men is expected to reduce mortality more than that estimated under historical screening. Limiting screening to men younger than 70 years is expected to help reduce overdiagnosis.

Capital and Chlordecone Poisoning in the French Caribbean Islands of Guadeloupe and Martinique: A Thesis on Crimes of the Market

ABSTRACT Guadeloupe and Martinique, two French overseas territories located in the Caribbean, are today facing serious public health crises; particularly, the highest rates of prostate cancer in the world. These crises resulted from the French colonial policy of primitive accumulation, which authorized two decades of the use of a carcinogenic pesticide, chlordecone (a.k.a. Kepone), by French settler farmers to control banana weevil pests. This was despite evidence of its lethal toxicity. Deploying the theoretical arguments of Market Criminology, this paper discusses the current health crises in both islands and the political economy of predation which created them as criminal. This is in sync with a growing body of literature which contextualizes preventable market-generated harms as criminal.

Abstract IA43: Biological and Social Influences on Disparities in Prostate Cancer Mortality

Abstract African descent men (ADM) across the African diaspora have the highest rates of prostate cancer (CaP) of any racial or ethnic group. The incidence rate in African American men (AAM) is 71% higher than in European American men (EAM) and the AAM mortality rate is 210% higher than EAM. Despite the public health implications of these observations, the underlying causes of this disparity remain unresolved, but are likely to involve a complex, multifactorial array of factors: There is substantial evidence that social inequities and access to health care are in part responsible for CaP disparities. Interventions aimed at early detection of CaP (e.g., PSA screening) or PCa treatments have not resulted in a substantial decrease in these disparities, although it is becoming increasingly clear that when screening and treatment are equitably applied, the disparity substantially decreases or disappears. However, while mortality rates have dropped for all men in the past decade, AAM have not experienced the same benefits from screening and early detection as have EAM. Similarly, new surgical, chemotherapeutic, antihormone, and radiological treatments have become available in recent years. These treatments also may not have been equally available to AAM and EAM or have not been optimized to the clinical setting relevant to AAM. For example, AA have different patterns of comorbidity than other groups, which may lead to sub-optimal including of AAM in clinical trials and thus sub-optimal application of these therapies in AAM. The only major risk factors for CaP mortality appear to be race, age, family history, or obesity. Beyond these, there is limited consistent evidence for exposures and environmental factors in CaP etiology or progression. CaP is strongly influenced by biological and genomic variation (germline and tumor), and there is growing evidence that the mutational landscape of prostate tumors varies substantially by race. These observations suggest that biological factors influence CaP incidence and tumor aggressiveness differentially by race and may in part explain CaP disparities by race. It is possible that some men, based on their biomarker profiles, have greater unfavorable prognosis than others, but screening and treatments are applied to all men without regard to their personalized risk profiles. Therefore, all of these factors, interacting with each other in a complex manner, may influence the disparity in CaP deaths between AAM and EAM. The influence of one or more of these factors may be manifest at different stages of the prostate carcinogenesis continuum. Thus, the interventions intended to act on these factors should be designed to target the timing of those influences and be tailored for diverse population groups. Since these factors are largely studied in isolation, it is difficult to optimize the intersectional effects of these factors to reduce CaP disparities. Citation Format: Timothy Rebbeck. Biological and Social Influences on Disparities in Prostate Cancer Mortality [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA43.

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 ...

Disparities in prostate cancer incidence and mortality rates: Solvable or not?

Prostate cancer (PCa) is recognized as a disease possessing not only great variation in its geographic and racial distribution but also tremendous variation in its potential to cause morbidity and death and it, therefore, ought not to be considered a homogenous disease entity. Morbidity and death from PCa are disproportionately higher in men of African ancestry (MAA) who are generally observed to have more aggressive disease and worse outcomes following treatment compared to men of European ancestry (MEA). The higher rates of PCa among MAA relative to MEA appear to be multifactorial and related to inherent differences in biological aggressiveness; a continued lack of awareness of the disease and methods of prevention; a lower prevalence of screen-detected PCa; comparatively lower access to quality healthcare as well as systemic and institutionalized disparities in the administration of optimal care to MAA in developed countries such as the United States of America where high-quality care is available. Even when access to quality healthcare is assured in equal access settings, it appears that MAA still have worse outcomes after PCa treatment stage-for-stage and grade-for-grade compared to MEA, suggesting that, inherent racial, ethnic and biological differences are paramount in predicting poor outcomes. This review has explored the different contributing factors to the current disparities in PCa incidence and mortality rates with emphasis on the incongruence in how research has been conducted in understanding the disease towards developing therapies.

Alarmingly High Rate of Prostate Cancer Detected by Routine Prostate-Specific Antigen Screening in a County HIV Clinic

Background Routine prostate-specific antigen (PSA) screening in the general population and in HIV-infected men is controversial. The aim of this study is to determine the prevalence of prostate cancer (PC) among patients living with HIV (PLWH).MethodsAfter an index case of PC was detected by sporadic PSA screening, we performed a prospective (2/2010–10/2016) cohort study following PSA levels and biopsies of African-American (AA) men ≥45 years and non-AA men ≥50 years. Screening was done at the discretion of the provider.ResultsOf the 124 men (82 AA, 17 Hispanic, 16 Caucasian, 7 Asian, 2 other) who received PSA screening, 7 (5.6%) had a PSA > 5 and underwent prostatic biopsy. Five patients (4%) were found to have PC, all of whom had a history of good long-term HIV virologic control. Mean age of PC patients was 60 years vs. non-PC patients (55 years) (P = 0.031). Mean years of HIV in PC patients was 18 years vs. non-PC patients (14 years) (P = 0.068).CaseAgeRacePSA Value (ng/mL)Stage/ Glisson ScoreRisk FactorsTreatment1 index case68AA133 + 3 = 6aTransplant recipientradiation258AA6.23 + 3 = 6aNoneProstatectomy pending364AA143 + 5 = 8a mets to nodesPaternal history PCRadical prostatectomy; hormone treatment458Caucasian7.64 + 3 = 7aNoneRadical prostatectomy560Caucasian9.93 + 3 = 6aNoneTransferred care aAll specimens positive for PC.ConclusionPSA screening is controversial and not universally recommended. Other retrospective studies of PLWH have shown equally high rates of PC. Compared with the general population (1/1,000 non-AA and 1.7/1,000 AA), men in our cohort had a 25 times higher rate (4%)of PC. All patients had aggressive tumors and required surgery, including one patient with metastasis to regional nodes. As expected, age was a significant risk factor for PC. We recommend implementing routine cohort PSA screening in PLWH.Disclosures All authors: No reported disclosures.

A Qualitative Study to Determine Barriers for Prostate Cancer Screening in Rural African-American Men.

African-American men have higher rates of prostate cancer and more advanced cancer when diagnosed than men of other ethnicities. To explore the perspectives and shared experiences of rural African-American men when it comes to interactions with healthcare providers, shared decision-making, and information on prostate cancer and screening. A convenience sample of African-American men in four rural counties in the southeastern United States agreed to participate. Semi-structured interviews of 43 men were conducted in patients' homes, classrooms, offices, and local churches. Lincoln and Guba's (1985) naturalistic approach was used. Analysis of the rich, in-depth narratives gleaned from these African-American men revealed three themes: 1) limitations in knowledge of prostate cancer, 2) poor patient/provider communication, and 3) deficient health literacy skills. Participants' perspectives about limited knowledge regarding PCa, variation in provider-patient communication and the finding of low health literacy skills expand knowledge, inform clinical practice, and provide evidence for further investigation to better provider communication and patient education concerning PCa and decision making in this population.

The Relation among Prostate Cancer Knowledge and Psychosocial Factors for Prostate Cancer Screening among African American Men: a Correlational Study.

African American (AA) men face disproportionately higher rates of prostate cancer (PCa) in comparison to other races. In addition, higher mortality rates from PCa amongst AA men signifies PCa as a formidable health disparity. Inconsistent PCa screening guidelines among medical organizations, further clouds one's decision on receiving a PCa screening. Examining various relations among factors which influence PCa screening may provide insight into their decision whether or not to receive a PCa screening. The purpose of the study was to examine the presence of associations among PCa knowledge, psychosocial factors, and PCa screening over a six month time frame. There were 76 participants at baseline, intervention group (n = 37) and control group (n = 35) and 54 participants, intervention group (n = 26) and control group (n = 28) remained at the 6 month follow up. At the six month follow up, the control group was more likely to have not received a PCa screening and the intervention group was more likely to have received a PCa screening, p < 0.01. PCa knowledge scores rose from 49% to 71%, intervention group, and 52% to 58%, control group. Significant associations were found among the following covariates, age and religion (rs = 0.499, p < 0.01), income and education (rs = 0.535, p < 0.01), income and healthcare coverage (rs = 0.528, p < 0.01), income and PCa knowledge at 6 months (rs = 0.424, p < 0.01), PCa screening and religion (rs = 0.353, p < 0.01), healthcare empowerment and preparation for decision making (rs = 0.421, p < 0.01), decisional self-efficacy and active surveillance knowledge (rs = 0.377, p < 0.01), and active surveillance knowledge and PCa knowledge (rs = 0.497, p < 0.01). The study revealed associations among PCa knowledge and psychosocial factors regarding a decision for PCa screening among the PCa high risk group, AA men.

Penile Metastasis Originating from Prostate Adenocarcinoma: An Unusual Presentation with Penile Curvature

: Despite the high rate of prostate cancer, the incidence of penile metastasis originating from prostate cancer is extremely rare, especially in the form of Peyronie’s disease. Moreover, brain metastasis, which is caused by prostate cancer, is not a common phenomenon and occurs mostly in older patients. Herein, we report a case of a middle-aged man with penile and brain metastasis originating from prostate cancer. The patient was presented with signs and symptoms of Peyronie’s disease without a significant increase in prostate specific antigen (PSA). The final pathological result was prostate adenocarcinoma with a Gleason score of 5 + 5 = 10 and neuroendocrine features.

Abstract 140: LSAMP gene deletion is associated with rapid disease progression in prostate cancer of African American men

Abstract INTRODUCTION: Disproportionately higher rates of prostate cancer (CaP) incidence and mortality have been reported among African American (AA) men. Although oncogenic TMPRSS2-ERG gene fusion and deletion of the PTEN tumor suppressor gene are established cancer driver gene alterations in CaP, they are known to be more prevalent among men of European ancestry. By utilizing carefully annotated specimens, this study focused on the discovery of recurrent genomic alterations in CaP of AA men in comparison to Caucasian Americans (CA). METHODS: Genomic DNA from clinically localized primary prostate tumors (Gleason 6 or 7 with primary pattern 3) and matched peripheral blood lymphocytes of seven AA and seven CA patients, were analyzed by paired-end sequencing on Illumina Genome Analyzer IIx to a depth of 30x. Following alignment to reference genome, somatic alterations on tumor DNA that include single nucleotide variants (SNVs), insertion and deletions (Indels), structural variations, copy number variations, and inter- and intra-chromosomal translocations of tumor DNA sequence were identified. To confirm prevalent genomic deletions we performed FISH analysis on a tissue microarray constructed from 42 AA and 59 CA tumor and normal samples of an independent cohort. Frequently deleted loci were further validated by analysis of TCGA CaP SNP array data from 41 AA and 279 CA prostate tumors. RESULTS: A comparative evaluation of whole genome sequences of AA and CA CaP revealed a prevalent deletion of the LSAMP locus of chromosome 3q13.31 in AA CaP. These observations were confirmed by SNP array and FISH assays in independent cohorts of specimens. AA CaP patients with LSAMP deletion showed rapid disease progression. In contrast to higher frequency of LSAMP deletion, significantly lower frequencies of PTEN and ERG alterations were noted in CaP of AA men. Furthermore, CaP genomes of AA men displayed a higher rate of inter-chromosomal rearrangements than those from CA men. CONCLUSIONS: We highlight distinct features of AA and CA CaP genomes including common CaP driver genes (TMPRSS2- ERG, PTEN) and define a novel recurrent deletion of the LSAMP locus. This study underscores the need for careful evaluations of cancer genomes in underrepresented populations in the global context with implications for precision medicine strategies. Citation Format: Albert Dobi, Gyorgy Petrovics, Hua Li, Shyh-Han Tan, Tanja Stümpel, Denise Young, Shilpa Katta, Qiyuan Li, Kai Ying, Bernward Klocke, Lakshmi Ravindranath, Indu Kohaar, Yongmei Chen, Dezső Ribli, Korbinian Grote, Hau Zou, Joseph Cheng, Clifton L. Dalgard, Shimin Zhang, István Csabai, Jacob Kagan, David Takeda, Massimo Loda, Sudhir Srivastava, Matthias Scherf, Martin Seifert, Timo Gaiser, David G. McLeod, Zoltan Szallasi, Reinhard Ebner, Thomas Werner, Isabell A. Sesterhenn, Matthew Freedman, Shiv Srivastava. LSAMP gene deletion is associated with rapid disease progression in prostate cancer of African American men. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 140.