Black Prostate Cancer Research Articles

Germline Variants in DNA Damage Repair Genes and HOXB13 Among Black Patients With Early-Onset Prostate Cancer.

Genetic studies of prostate cancer susceptibility have predominantly focused on non-Hispanic White men, despite the observation that Black men are more likely to develop prostate cancer and die from the disease. Therefore, we sought to identify genetic variants in Black patients diagnosed with early-onset prostate cancer. Whole-exome sequencing of germline DNA from a population-based cohort of Black men diagnosed with prostate cancer at age 62 years or younger was performed. Analysis was focused on a panel of DNA damage repair (DDR) genes and HOXB13. All discovered variants were ranked according to their pathogenic potential based upon REVEL score, evidence from existing literature, and prevalence in the cohort. Logistic regression was used to investigate associations between mutation status and relevant clinical characteristics. Among 743 Black prostate cancer patients, we identified 26 unique pathogenic (P) or likely pathogenic (LP) variants in 14 genes (including HOXB13, BRCA1/2, BRIP1, ATM, CHEK2, and PALB2) among 30 men, or approximately 4.0% of the patient population. We also identified 33 unique variants of unknown significance in 16 genes among 39 men. Because of the rarity of these variants in the population, most associations between clinical characteristics did not achieve statistical significance. However, our results suggest that carriers for P or LP (P/LP) variants were more likely to have a first-degree relative diagnosed with DDR gene-associated cancer, have a higher prostate-specific antigen at time of diagnosis, and be diagnosed with metastatic disease. Variants in DDR genes and HOXB13 may be important cancer risk factors for Black men diagnosed with early-onset prostate cancer, and are more frequently observed in men with a family history of cancer.

Insufficient Lycopene Intake Is Associated With High Risk of Prostate Cancer: A Cross-Sectional Study From the National Health and Nutrition Examination Survey (2003-2010).

Although lycopene intake and risk of prostate cancer have been explored for decades, recent studies show that Non-Hispanic Black Prostate Cancer (PCa) patients benefit less than Non-Hispanic White patients from a lycopene intake intervention program. This study examined whether a lycopene intake-related racial disparity exists in reducing the risk of PCa in healthy adults. Data on healthy, cancer-free Non-Hispanic Black (NHB) men (n = 159) and Non-Hispanic White (NHW) men (n = 478) from the 2003 to 2010 NHANES dataset were analyzed. Total lycopene intake from daily diet, age, living status, race/ethnicity, education level, poverty income ratio, body mass index, and smoking status were studied as independent variables. The combination of total Prostate-Specific Antigen (PSA) level and the ratio of free PSA was set as criteria for evaluating the risk of PCa. Multivariable logistic regression was used in race-stratified analyses to compute odds ratios (OR) and 95% confidence intervals (95% CI) comparing high PCa risk with low PCa risk. We found, in the whole population, race/ethnicity was the only factor that influenced lycopene intake from the daily diet. NHB men consumed less lycopene than NHW men (3,716 vs. 6,487 (mcg), p = 0.01). Sufficient lycopene intake could reduce the risk of PCa (OR: 0.40, 95% CI: 0.18–0.85, p = 0.02). Men aged between 66 and 70 had high PCa risk (OR: 3.32, 95% CI: 1.12–9.85, p = 0.03). Obesity served as a protective factor against the high risk of PCa (OR: 0.25, 95% CI: 0.12–0.54, p = 0.001). NHW men aged between 66 and 70 had a high risk of PCa (OR: 4.01, 95% CI: 1.02–15.73, p = 0.05). Obese NHW men also had lower risk of PCa (OR: 0.18, 95% CI: 0.07–0.47 p = 0.001). NHB men had a high risk of PCa compared to NHW men (OR: 2.27, 95% CI: 1.35–3.81 p = 0.004). NHB men who were living without partners experienced an even higher risk of PCa (OR: 3.35, 95% CI: 1.01–11.19 p = 0.07). Sufficient lycopene intake from daily food could serve as a protector against PCa. Such an association was only observed in NHW men. Further studies are needed to explore the dose-response relationship between lycopene intake and the association of PCa risk in NHB men.

African-centered coping, resilience, and psychological distress in Black prostate cancer patients.

Blacks have the highest incidence and mortality rates for prostate cancer (PCa) in the U.S. Black PCa patients (PCaP) also report high psychological distress. Identifying culturally specific coping strategies that lower distress among Black PCaP could help improve psychological interventions for this group. African-centered coping (strategies unique to the structure of Black personality and the African-centered worldview) have been identified. We hypothesized that these coping strategies and resilience would be associated with lower psychological distress (anxiety and depression) in Black PCaP. Black PCaP (N=95) completed a survey assessing African-centered coping strategies, resilience, anxiety, and depression. Multiple regression was employed to examine African-centered coping strategies and resilience as predictors of psychological distress. Participants were aged M=67±9years and 52% had late-stage PCa. Twenty percent met criteria for clinically significant anxiety, and 17% for depression. African-centered coping strategies were not associated with lower anxiety or depression, while resilience was associated with decreased anxiety (r=-0.45, p<0.001) and depression (r=-0.54, p<0.001). Mediation analyses did not support an indirect association among African-centered coping strategies, resilience, and anxiety and depression. Contrary to hypotheses, African-centered coping strategies were not associated with psychological distress. However, as predicted, greater resilience was associated with lower anxiety and depression. These findings support the relevancy of resilience in Blacks' psychological adjustment to PCa. It might be worthwhile to explore African-centered coping strategies that help Black PCaP cope with distress.

Cancer Survivorship: Religion in Meaning Making and Coping Among a Group of Black Prostate Cancer Patients in South Africa

The purpose of the study was to explore the role of religion in meaning making and coping among a group of black patients receiving some form of prostate cancer treatment at a public hospital in Limpopo Province, South Africa. A sample of 20 prostate cancer survivors, with ages ranging from 67 to 85 years (meanage = 76yrs; SD = 5.3) selected through purposive sampling. Data were collected through in-depth, semi-structured individual interviews and analysed using interpretative phenomenological analysis (IPA). The findings demonstrated that religion is an important factor in meaning making and coping by prostate cancer survivors. The findings suggest that healthcare practitioners need to pay close attention to the meanings that cancer patients assign to their illness to provide the appropriate care and support.

Information Needs of Black Prostate Cancer Patients Receiving Treatment Within the South African Public Healthcare System.

IntroductionProstate cancer is the leading cancer type in black South African men. The South African public healthcare sector serves more than 84% of the population, which includes many of these men. Previous evidence suggests that patients’ information needs are influenced by culture. No studies could be found that explored the information needs of black men diagnosed with prostate cancer in a developing country from the patients’ perspectives. Therefore, this study set out to investigate the information needs of black men diagnosed with prostate cancer in a South African public healthcare setting.MethodsNine participants who had completed a radical course of external beam radiation therapy for prostate cancer were interviewed. These participants had gained experience from their cancer journey in this setting and could therefore provide information-rich perspectives about their information needs from the time of diagnosis to end of treatment. Interviews were conducted in the participants’ preferred language, with three interviews conducted in Zulu with an English translator.ResultsImportant themes that emerged included patients' desire to receive more information regarding what was happening in the diagnosis stage, the implications of having prostate cancer and the origin of their symptoms. The participants expressed a need to understand the potential side effects of radiation therapy, the reason for bladder filling and on-treatment set-up imaging verification. Participants also wanted to know how they should care for themselves and adjust their lifestyles, and required more information about follow-up tests and appointments.ConclusionIn South Africa, black men with prostate cancer expressed the need for more information about the implications of a prostate cancer diagnosis, the reasons for these treatments and what they were expected to do. They also require information about where to go and what will happen in the different parts of the healthcare system with regard to the diagnosis and treatment of the prostate cancer. Communities should also be educated about cancer to avoid misconceptions. In South Africa, healthcare workers should consider the life-worlds of black men in the public healthcare system when attending to their information needs.

Abstract C007: Racial differences in feasibility and perceived value of electronic symptom monitoring in a cohort of Black and White bladder and prostate cancer patients

Abstract Background Racial differences in cancer-related symptom burden are well-documented, and partly linked to inequities in symptom monitoring. Electronic patient-reported outcomes (ePROs) are useful for symptom monitoring, but have rarely been evaluated in diverse patient populations. We implemented an ePRO tool among a cohort of Black and White cancer patients and evaluated (1) whether ePRO use was perceived as feasible and valuable for symptom management; and (2) if perceptions of feasibility and value differed by race. Methods We recruited 30 Black and 50 White bladder and prostate cancer patients from a single institution. Participants completed ePRO assessments prior to, during, and 3 months following completion of cancer treatment. Participants were given the option of reporting symptoms using a web- or phone-based system. A subset of participants completed end-of-study satisfaction surveys (n=9 Black; n=25 White) and qualitative interviews (n=15 Black; n=25 White) assessing ePRO feasibility and value. We analyzed end-of-study surveys and qualitative interview data, evaluating race-specific differences in user experiences with the ePRO tool. Results Both Black (77.8%) and White (96.0%) participants more commonly reported using the web-based system for symptom reporting, with the majority of participants reporting being “very satisfied” with the web-based system (71.4% Black; 66.7% White). Whites more commonly reported high levels of ease in understanding and answering symptom assessment items compared with Blacks (44.4% Black; 56.0% White). In interviews, Blacks expressed stronger preferences for phone-based and paper-based reporting due to ease in facilitating understanding of symptom items. In terms of perceived value, Blacks more often reported that the ePRO tool was “very helpful” in reminding them of symptoms experienced in the last seven days (55.6% Black; 36.0% White). In interviews, Blacks also described how the ePRO helped them better understand symptoms, while Whites noted finding value in better understanding symptoms and the ability to track their symptoms over time. Black and White respondents commonly reported that doctors communicated with them about ePRO-reported symptoms (88.9% Black; 84.0% White), but Blacks more often reported that the ePRO tool was “very helpful” in speaking to doctors about symptoms (44.4% Black; 24.0% White). In interviews, both Black and White participants indicated that ePRO use prompted more in-depth discussions about symptoms and treatment options with providers. Conclusion Electronic symptom monitoring is perceived as valuable among Black and White cancer patients. Greater perceived value of ePROs among Blacks may have implications for addressing systemic drivers of symptom disparities. As oncology practices move towards broader implementation of ePROs, it will be important to consider the health literacy needs and ePRO modality preferences of patients, in order to promote equitable adoption of electronic symptom monitoring. Citation Format: Cleo A. Samuel, Angela Smith, Ronald Chen, Wendi Elkins, Jennifer Richmond, Zahra Mahbooba, Dana E. Mueller, Ethan Basch, Antonia V. Bennett, Arlene E. Chung, Bryce B. Reeve. Racial differences in feasibility and perceived value of electronic symptom monitoring in a cohort of Black and White bladder and prostate cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C007.

Abstract A121: Uncovering research gaps and strategizing future efforts: NCI Think Tank on multiple myeloma and disparities

Abstract One of the National Cancer Institute's (NCI) priority research areas is understanding the underlying causes of cancer health disparities. In recent years, there have been multiple efforts focusing on the disparities that exist within various cancer types, for example, the higher risk of triple-negative breast cancer in black women and prostate cancer in black men. One disease in which disparities are seen prominently is multiple myeloma (MM), the second most common hematologic malignancy, with an estimated 31,000 new cases to be diagnosed in 2018. Despite new treatments significantly improving survival rates, MM remains incurable and incidence rates continue to increase. Furthermore, the burden from MM and its premalignant conditions, monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), is not shared equally across racial/ethnic groups in the US. Blacks have the highest incidence of MGUS and MM, with a rate 2-3 times higher than non-Hispanic whites. Blacks and Hispanic/Latinos are more likely to experience an earlier age of onset, and blacks are twice as likely to die compared to other racial/ethnic groups, even when matched for socioeconomic and other factors, suggesting that biologic differences may play an important role in the observed disparity. To understand the current state of MM research in the context of disparities, a trans-NCI group organized a one-and-a-half-day Think Tank and Provocative Question (PQ) Session on March 5-6, 2018. Over 35 MM researchers and more than 20 NCI staff from disciplines spanning the cancer continuum attended. The meeting began with the PQ session, which was designed to challenge participants to think creatively about MM and disparities and discuss understudied research questions that, if answered, could move the field forward. The Think Tank uncovered gaps and identified challenges that hinder progress in understanding progression from normal to premalignant conditions to MM in different racial/ethnic populations. The final portion of the day was dedicated to discussing strategies for accelerating the field. The subject matter experts identified several scientific and resource gaps that are barriers to making progress in this area. These included the need for hematologic malignancy models (cell lines and PDX models) from diverse populations, serial biospecimen collection from MGUS, SMM and MM patients of various racial/ethnic groups, and increased clinical trial accrual of minorities. Areas of research that were considered priorities to understand the underlying causes of increased incidence among different populations included biomarker discovery to identify high-risk patients, increased use of multiple ‘omics analysis, and understanding the role of the immune system. Another priority discussed was the need for innovative sensing technology for accurate detection of the premalignant MGUS. The NCI is pursuing several areas that are ripe for further investment to help eliminate the disparities in multiple myeloma. Citation Format: Amy E. Kennedy, L. Michelle Bennett. Uncovering research gaps and strategizing future efforts: NCI Think Tank on multiple myeloma and disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A121.

An Exploration of Precancer and Post-Cancer Diagnosis and Health Communication Among African American Prostate Cancer Survivors and Their Families.

Prostate cancer is the second most common cancer among American men, with Black men at the highest risk for the disease. Few studies have been published on how communication between Black prostate cancer survivors and their family members affect health outcomes and subsequent health communication. The purpose of this study was to understand cancer and health communication among Black prostate cancer survivors and their families before and after disclosing their diagnosis. Through a mixed method design, 11 Black prostate cancer survivors participated from the Southeastern region of the United States, completed questionnaires, and took part in a focus group. The study utilized 4 focus groups of Black prostate cancer survivors ranging in age from 51 to 76 years. Descriptive statistics revealed 91% (n = 10) of participants indicated they could openly discuss health issues in their family and 82% (n = 9) indicated a female relative as the person responsible for teaching about health. An analysis of the transcripts revealed four themes utilizing thematic network: (a) communication over the life course of the prostate cancer survivor, (b) parents’ communication with family, (c) disclosing prostate cancer diagnosis, and (d) treatment options for prostate cancer. Results suggested the participants recognized the importance of discussing prostate cancer with their families to reduce fears and misconceptions about the disease. Through the exploration of cancer and health communication within Black families, solutions can be derived for increasing health behaviors and health knowledge among men.

Black men and prostate cancer in the UK

Black men and prostate cancer in the UK

Abstract 4204: Racial difference in the risk of secondary bladder cancer following radiation therapy among prostate cancer patients

Abstract Purpose: Radiation therapy has been found associated with increased risk of secondary bladder cancer diagnosis among prostate cancer patients. It is unknown whether this association varies by race. This study aimed to investigate whether the association between radiation and secondary bladder cancer differs for white vs. black prostate cancer patients. Methods: Data on white or black men who were diagnosed with primary localized prostate cancer in Louisiana between 2004 and 2013 and received radiation only or surgery only were obtained from Louisiana Tumor Registry. We excluded those who developed secondary bladder cancer within 180 days of the prostate cancer diagnosis or had follow-up less than 180 days or with unknown tumor size or Gleason score. Every patient was followed up until the end of 2016. The exposure variable was treatment (radiation only vs. surgery only). The outcome variable was the diagnosis of secondary bladder cancer and the time from prostate cancer diagnosis to secondary bladder cancer diagnosis or to loss to or end of follow-up. Covariates included age at diagnosis, marital status, insurance, census tract level poverty, tumor size, and Gleason score group. The competing risk survival analysis was applied. Death during follow-up was considered as competing event. Analysis was stratified by race. Results: Of 10,861 white and 5,117 black prostate cancer patients, 52.7% and 56.8% received only radiation respectively. Regardless of race, patients who only received surgery were younger, more likely to be married, privately insured, live in low poverty census tract, and have smaller or lower grade tumor (P &amp;lt;0.0001 for each in both racial groups). Among white prostate cancer patients who received surgery only vs. radiation only, 31 (0.60%) vs. 127 (2.22%) of them developed secondary bladder cancer (P &amp;lt; 0.0001). Among black surgery only vs. radiation only patients, 14 (0.63%) vs. 29 (1.00%) of them developed a secondary bladder cancer (P = 0.16). The median follow-up time was 8.9, 8.0, 8.3, and 7.6 years for white surgery, white radiation, black surgery, and black radiation patients, respectively. After adjusting for covariates, the hazard ratio (95% confidence interval) [HR (95% CI)] of developing secondary bladder cancer was 2.70 (1.58, 4.61) for white radiation patients compared to white surgery patients; 0.95 (0.31, 2.89) for black radiation patients compared to black surgery patients. Compared to white surgery patients, the HR (95% CI) of developing secondary bladder cancer was 1.16 (0.61, 2.22) and 1.38 (0.74, 2.56) for black surgery and black radiation patients, respectively. Conclusions: Radiation is associated with increased risk of secondary bladder cancer among white prostate cancer patients, but not among black patients. Early screening of secondary bladder cancer need to be emphasized among white prostate cancer patients who received radiation therapy. Citation Format: Lu Zhang, Mei-Chin Hsieh, Qingzhao Yu, Xiao-Cheng Wu. Racial difference in the risk of secondary bladder cancer following radiation therapy among prostate cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4204.

Association between smoking and neutrophil to lymphocyte ratio among prostate cancer survivors: the National Health and Nutrition Examination Survey.

BackgroundAn elevated neutrophil to lymphocyte ratio (NLR) has been proven as a vital predictor of progression and mortality for prostate cancer. Smoking is a risk factor for increasing NLR. The objective of this study is to examine the effect of smoking on NLR among prostate cancer survivors.MethodsA total of 354 men adults aged ≥20 years old with prostate cancer were analyzed using the National Health and Nutrition Examination Survey (NHANES) 2005–2016 data. The primary outcome was NLR, which was classified into two levels: high (≥3) and low (<3). Sampling weighted logistic regressions were used for evaluating associations between smoking and NLR among prostate cancer survivors.ResultsThis study found that 33.2% (n=111) of prostate cancer survivors had an elevated NLR. Prostate cancer survivors with a high NLR were older (mean 73.5 years old), non-Hispanic white (38.5%), higher income (poverty income ratio >1, 34.7%), and longer years after diagnosis (8.8 years) compared to counterparts with a low NLR. Smoking status did not have a significant impact on NLR. The interaction test between race and smoking status was significant (P=0.04). Non-Hispanic black who were current smokers were observed more likely to have high NLR than never smokers [adjusted odds ratio (OR) =3.69, 95% CI: 1.36–9.99]. However, the effect of smoking on NLR was not observed among either non-Hispanic whites or other races.ConclusionsNon-Hispanic black prostate cancer survivors who were a current smoker were more likely to have NLR ≥3 compared to non-smokers. Smoking cessation could benefit these patients in prostate cancer management and reduce the risk of progression and mortality.

A Qualitative Study of Psychosexual Implications of Prostate Cancer among Black Prostate Cancer Survivors

A Qualitative Study of Psychosexual Implications of Prostate Cancer among Black Prostate Cancer Survivors

Job Market Prospects of Breast vs. Prostate Cancer Survivors in the US: A Double Hurdle Model of Ethnic Disparities

Labor market presence of cancer survivors has been significantly improved as medical technology revolutionized cancer-specific diagnoses and treatments. However, less understood are post-cancer variations in job market outcomes of racial and ethnic minorities in the US. Using a theoretical framework derived from family labor supply decision models and taking advantage of the rich data in the 2008–2014 Medical Expenditure Panel Survey (MEPS), this study employs a double-hurdle empirical model of labor force participation and hours worked to evaluate the employment decisions of Black and Hispanic cancer survivors. Hispanic and Black breast cancer survivors were less likely to be employed by 4% and 7.5%, respectively, when compared with Whites. Black prostate cancer survivors were 8% less likely to work than Whites, with nonsignificant differences between Hispanic and White prostate cancer survivors. Once employed, Black and Hispanic breast cancer survivors worked an extra 4 and 6 h than Whites, while Hispanic prostate cancer survivors worked 5 fewer weekly hours than Whites. In addition, our estimates indicate the significance of job types in labor market outcomes post-cancer. Employment of minorities in blue collar or service occupations decreased employment hours of survivors. Labor market disparities for minorities amplifies the socio-economic and familial burden of cancers. This timely work motivates informed public policy to reduce unexamined consequences of chronic conditions among minorities.

The association of metformin use with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study.

Metformin has been associated with a reduced incidence of prostate cancer and improved prostate cancer outcomes. However, whether race modifies the association between metformin use and prostate cancer aggressiveness remains uncertain. The association between metformin use and prostate cancer aggressiveness was examined separately in Black Americans (Blacks) and White Americans (Whites). The study population consisted of 305 Black and 195 White research participants with incident prostate cancer and self-reported diabetes from the North Carolina-Louisiana Prostate Cancer Project. High-aggressive prostate cancer was defined using a composite measure of Gleason sum, prostate-specific antigen, and clinical stage. Multivariable logistic regression was used to assess the association between metformin use and high-aggressive prostate cancer at diagnosis, separately among Whites and Blacks, with adjustment for age, screening history, site, education, insurance, and body mass index. Metformin use was associated positively with high-aggressive prostate cancer in Blacks (OR 2.01; 95% CI 1.05, 3.83). By contrast, a weak inverse association between metformin use and high-aggressive prostate cancer was found in Whites (OR 0.80, 95% CI 0.34, 1.85). The association between metformin use and prostate cancer aggressiveness may be modified by race.

Quality of Life Among Black Prostate Cancer Survivors: An Integrative Review.

The purpose of this integrative review was to explore the impact of prostate cancer (PCa) on the quality of life (QoL) and factors that contribute to the QoL for Black men with PCa. Prostate is recognized as the prevalent cancer among men in the United States. Compared to other men, Black men are diagnosed more frequently and with more advanced stages of PCa. Black men also experience disproportionately higher morbidity and mortality rates of PCa, among all racial and ethnic groups. The initial diagnosis of PCa is often associated with a barrage of concerns for one’s well-being including one’s QoL. As a result, men must contend with various psychosocial and physiological symptoms of PCa survivorship. Whittemore and Knafl’s integrative review method was utilized to examine empirical articles from the electronic databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed, Project Muse, and Google Scholar. The time frame for the literature was January 2005 to December 2016. A synthesis of the literature yielded 18 studies that met the inclusion criteria for the integrative review. A conceptual framework that examined QoL among cancer survivors identified four domains that measured the QoL among Black PCa survivors: (a) physical; (b) psychological; (c) social; and (d) spiritual well-being. Social well-being was the dominant factor among the studies in the review, followed by physical, psychological, and spiritual. Results indicate the need for additional studies that examine the factors impacting the QoL among Black PCa survivors, using a theoretical framework so as to develop culturally appropriate interventions for Black PCa survivors.

The role of the percentage free PSA in the diagnosis of prostate cancer in Blacks: Findings in indigenous West African men using TRUS guided biopsy

IntroductionIn Western and Asian literature, the measurement of percentage free prostate specific antigen (%fPSA) has been known to enhance the predictive role of total prostate specific antigen (tPSA) in early prostate cancer (Ca-P) detection. Relationship between the tPSA and Ca-P are known to be influenced by race. To the best of our knowledge, the relationship between %fPSA and Ca-P has not been studied in sub-Saharan Africa using current established biopsy protocol. ObjectiveTo evaluate the usefulness of %fPSA in indigenous West African men and determine the appropriate cut-off values that may be used as indication for prostate biopsy in men with tPSA of 4–10ng/ml. Subjects and methodsA total 169 consecutive patients with tPSA of 4–10ng/ml with non-suspicious findings on digital rectal examination (DRE) had a transrectal ultrasound (TRUS) guided 10-core prostate biopsy. The technique of PSA analysis was the Access hybritech assay technique using the Beckman's Access autoimmuno analyser. The rates of prostate cancer in different %fPSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate the efficiency of %fPSA in the diagnosis of prostate cancer. ResultsA reduction %fPSA was associated with a higher detection rate of Ca-P. There was a 62% prevalence of Ca-P with %fPSA≤10% while there was a zero prevalence in patients with fPSA above 20%. At a %fPSA cut off of 20% the sensitivity and specificity were 100% and 45%, respectively. Using the ROC curve, the area under the curve (AUC) was 0.76 while the ROC decision plot showed that a %fPSA cut off 15% was associated with the highest ability to discriminate between benign and malignant diseases. ConclusionThe %fPSA is an effective discriminating tool in determining the need for prostate biopsy in indigenous West African men with PSA 4–10ng/ml. A cut off of 15% was associated with the highest performance.

Photovoice: a Link between Research and Practice for Prostate Cancer Advocacy in Black Communities

Persisting high rates of prostate cancer incidence and mortality in Black communities have led to the development of many community-based interventions aimed at raising knowledge levels among these communities. There is limited research examining how advocates are reaching out to communities, or how advocates see their work impacting the communities. Using photovoice methods, four self-identified Black prostate cancer advocates were invited to document their experiences through photographs about what advocacy means to them and how they advocate. Meaningful photographs were taken by advocates and accompanied by powerful narratives. The advocates focused their projects on reaching men on their level, advocacy as an active process, and providing insight into the experiences surrounding prostate cancer. These photographs also have potential to be integrated in future outreach interventions. This project promotes further understanding of how these men advocate for prostate cancer awareness within Black and underserved communities, and how the research method of photovoice can be leveraged in future outreach programs and interventions.

Abstract A39: Profiles, motivations, and networks of prostate cancer advocates in southern black communities

Abstract Black men have the highest number of new cases and mortality rates for prostate cancer: 1.6 and 2.4, respectively when compared to whites (NCI, 2015). Also, black men are more likely to have an advanced stage and grade of prostate cancer at initial presentation. Prostate cancer disparities are a complex problem that needs to be assuaged with complex and multifaceted strategies. Advocates can be one of the many tools used to alleviate the prostate cancer health disparities that are observed today in black communities. While there is no shortage of research being done on black men and prostate cancer, there is a very little research on the work of advocates for prostate cancer awareness in black communities. Advocates are already engaging on different levels with black communities to increase prostate cancer awareness. This research seeks to further illuminate the advocates' efforts and voices, exploring their strategies and approaches. Through the use of qualitative methods, data collection yielded a total of 24 in-depth interviews and 14 ethnographic observations. These expanded methods capture a more nuanced and complex understanding of prostate cancer advocacy. Major findings include (1) the description of the advocates, including their demographics and self-definitions, (2) the interrelated internal and external sources of motivation for their advocacy efforts; and (3) an examination of the complex networks of advocacy that incorporate social networks, organizations, and research and political entities. These insights can help to create and support more effective interventions that are specifically developed for men in black communities. Citation Format: Lauren Rose Gilbert. Profiles, motivations, and networks of prostate cancer advocates in southern black communities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A39.

Abstract C41: Serum vitamin D and risk of prostate cancer among black men in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial

Abstract Introduction: Cohort studies and meta-analyses suggest higher circulating 25-hydroxyvitmain D (25(OH)D) is associated with increased prostate cancer risk. The association has largely been defined in non-Hispanic white populations. Using data from the PLCO Trial, we prospectively examined the association between circulating 25(OH)D and prostate cancer risk in black men, a group with lower circulating vitamin D and higher prostate cancer rates relative to other racial/ethnic groups. Methods: This nested case-control analysis included 226 black prostate cancer cases and 452 controls matched 2:1 based on age at randomization (+/- 5 years), date of blood draw (+/- 30 days), and calendar-year of entry into the cohort. Serum 25(OH)D was measured using liquid chromatography-mass spectrometry (LC/MS), and we estimated odds ratios (OR) and 95% confidence intervals (CI) for prostate cancer by quartiles and clinically defined cut-points (&amp;lt;25, 25-50, and 75+, with 50-&amp;lt;75 nmol/L as the referent group) of baseline 25(OH)D from multivariable conditional logistic regression models. Two methods were used to adjust for seasonal variation in 25(OH)D: 1) quartiles created for sunnier (May-October) and darker (November-April) months were combined to create season-specific quartiles; 2) 25(OH)D was regressed on week of blood draw and the residuals were used to create season-standardized quartiles. Risk of total, aggressive (clinical stage III or IV or Gleason score ≥7) and non-aggressive (clinical stage I or II and Gleason score &amp;lt;7) disease were determined. Results: We found statistically non-significant associations between circulating 25(OH)D and risk of total prostate cancer in black men (season-specific Q4 vs. Q1 OR=0.83, 95% CI:0.42-1.67, P for trend = 0.41). For non-aggressive disease, the association was inverse (global P-value = 0.025), particularly in the 3rd quartile: Q3 vs. Q1 OR= 0.17, 95% CI: 0.06-0.55, Q4 vs. Q1 OR= 0.62, 95% CI: 0.23-1.71, P for trend =0.10). In contrast, the association with aggressive disease, while non-significant, appeared positive (Q4 vs. Q1 OR=1.18, 95% CI: 0.38-3.62, P for trend = 0.77). Similar results were obtained for total, non-aggressive, and aggressive prostate cancer using season-standardized quartiles of 25(OH)D. There was no evidence of an association with total prostate cancer using clinically defined cut-points, although categories above and below the referent category appeared to be inversely associated with risk of aggressive disease, while positively associated with risk of non-aggressive disease. We found no evidence of a difference in our findings for total prostate cancer and 25(OH)D when stratified by median total vitamin D intake, family history of prostate cancer, smoking status, physical activity, aspirin use, or body mass index. Conclusions: Our analysis of circulating 25(OH)D and prostate cancer risk among black men indicates a possible modest inverse association with total prostate cancer risk. This was reflective of the association with non-aggressive disease, where circulating 25(OH)D had a protective effect, but not for aggressive disease. Our finding of potential variability in the vitamin D-prostate cancer risk association by disease aggressiveness may be related to differences in pathogenesis and prognosis of indolent and aggressive prostate cancers. Our study adds to the limited prospective research addressing this relationship in a high risk population. Additional studies of the vitamin D-prostate cancer risk association in black men are needed. Citation Format: Tracy M. Layne, Stephanie Weinstein, Xiaomei Ma, Barry I. Graubard, Susan T. Mayne, Demetrius Albanes. Serum vitamin D and risk of prostate cancer among black men in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C41.

Abstract A30: Supporting prostate cancer survivor advocacy through community-based participatory research and photovoice methods

Abstract This study examines the utilization of survivor advocates in prostate cancer awareness outreach efforts within the black community. Persisting health disparities exist when it comes to prostate cancer morbidity and mortality for black men compared to white men. There is consensus that an appreciable portion of these disparities persist because of insufficient knowledge about prostate cancer and insufficient access to regular health care. This research project examines black prostate cancer survivors as advocates for prostate cancer awareness and screening education, and more general outreach efforts in black communities. Survivor advocates can not only give insight into the perceptions, beliefs and behaviors of men in the black community, but can also serve as mediators between their communities and the health care system. Because prostate cancer is not experienced by only the men, other stakeholders will be included in the project, such as significant others, family members and health care providers. These views will provide a more nuanced understanding of the interplay between the knowledge, uptake, and subsequent actions of these men. Using a combination of ethnographic observations, in-depth interviews, and photovoice methods in a community based participatory research (CBPR) approach, this qualitative project calls attention to the experiences of survivor advocates, as well as other important stakeholders, allowing for a better understanding of the interplay between the knowledge, uptake, and subsequent actions of these men. By using the CBPR approach and these methods, the project will be culturally sensitive and competent, providing a culturally enriched approach to advocacy and more broadly, addressing the existing health disparities in prostate cancer. Based on the preliminary results and analysis, these survivors have a unique perspective on prostate cancer awareness and screening. Advocacy for prostate cancer awareness is a complex process, involving different approaches and strategies. The men fight against fears associated with prostate cancer, such as homophobia with screening exams, cancer as a death sentence, and possible sexual dysfunction. The advocates dispel these fears and concerns by replacing them with knowledge about early detection, the variety of treatment options, and ways to deal with sexual dysfunction, including emphasizing overall health. They also deal with the feelings of invulnerability when it comes to prostate cancer. The main focus of advocacy is to encourage other men to make informed decisions about prostate cancer. By sharing their own experiences, the advocates are also able to make their messages more relatable for the men. Survivor advocates empower the community by (1) providing a trusted and legitimate voice to the community about sensitive and sometimes confusing topics, and (2) being equal partners in the research through the CBPR approach. Furthermore, advocacy creates an ongoing campaign of prostate cancer awareness and screening education, instead of a single point intervention. By engaging these men and becoming more aware of their motivations and barriers to advocacy, better programs and supports can be created for them with their input. This project will be used as a framework to create an advocacy toolkit and training program. Citation Format: Lauren R. Gilbert. Supporting prostate cancer survivor advocacy through community-based participatory research and photovoice methods. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A30.