A recent review examined the molecular and genomic differences of prostate cancer between African-American and Caucasian men in the United States (Cancer Rep 2021; https://doi.org/10.1002/cnr2.1340). The study authors concluded that these differences could be used to improve the diagnosis and treatment of African Americans with prostate cancer, which will ultimately lower the incidence and mortality rates in this patient population.
The higher incidence and mortality among African Americans with prostate cancer is well-established. These disparities have been linked to multiple socioeconomic factors, health care access, and tumor biology.
"When you look at a prostate cancer mortality. It is obvious that disparities exist. African-American men have twice the mortality than any other ethnic group," noted senior author Ashutosh Tewari, MD, Chair of the Department of Urology at Mount Sinai Health System. "We have the same cancer and geographic landscape yet two groups of people with significantly different outcomes.
"This is very troubling and, as a surgeon scientist, I have a role to play in fixing this problem. I want to be part of the solution in this equation," he continued. "And so, in an effort to address these disparities, we sought to better understand why mortality is so much higher among these patients."
A Comprehensive Review
The main drivers of racial disparities among prostate cancer patients include socioeconomic factors, health care access issues, and tumor biology, according to this report.
Following an extensive review of recent research, Tewari and colleagues emphasized the importance of a deeper understanding of both clinical and molecular differences to facilitate improved outcomes among African Americans.
"We provide a comprehensive review of the significant research in recent years that has examined the molecular and genomic reasons for unequal cancer burden in African-American and Caucasian-American populations and acknowledge the challenges that lie ahead," stated Tewari. "This article provides specific guidelines for managing prostate cancer in African-American men based on their disease's biology and makes a significant contribution to the ongoing national effort to improve African-American men's outcomes from prostate cancer."
The researchers noted that recent epidemiological studies have shown that when African Americans with prostate cancer have equal access to diagnosis and treatment, disparities in outcomes no longer exist. However, Tewari and colleagues emphasized that differences in incidence remain and there is significant work to be done to reverse disparities in mortality.
During their review, the study authors discussed prostate cancer oncogenesis. They highlighted key molecular and genomic differences in African-American patients with prostate cancer that have been identified through recent research. Tewari and his team also noted the important role of the tumor microenvironment and its impact on unequal cancer burden and differences in clinical outcome among races.
The study authors emphasized the pressing need for further research on risk stratification to allow for the identification of African Americans with "higher risk disease based on their unique clinical, genomic, and immunological profiles, which can then be mapped to appropriate clinical trials."
"Molecular factors are intertwined with a patient's own response towards health care, as well as socioeconomic issues, including access to care," explained Tewari, who noted the importance of recognizing the impact all these elements have on outcomes for this patient population.
"By gaining a deeper understanding of the specific biology of prostate cancer in African-American men, we can develop a precision medicine approach for this patient population," he noted. "Significant work remains to address current disparities and improve outcomes."
Taking Action
Based on their review, the study authors highlighted several actional items that could help contend with the disparities seen between African-American and Caucasian men with prostate cancer.
A key area of focus is prevention. Research has identified abnormalities in prostate cancer associated with obesity, hypertension, and diabetes among African-Americans. Tewari and colleagues highlighted findings that provide insight into the "the intersection of prostate cancer with dietary and social behaviors in African-American men that may result from underlying socioeconomic issues."
Current research emphasizes the value of maintaining a healthy lifestyle and supports public health efforts to lower their incidence of prostate cancer in this patient population, according to the study authors.
To improve early diagnosis and potentially lessen incidence and mortality among these patients, Tewari and colleagues recommend addressing lifestyle, behavior, and issues related to health care access, as well as a focus on comorbidities for African-American men and inflammatory etiological associations as they relate to disparities in prostate cancer outcomes.
In an effort to address the significant racial disparity in prostate cancer, Mount Sinai is launching a Mobile MRI Unit in Summer 2021. This program seeks to support prostate health among African Americans in New York City neighborhoods, specifically Harlem, Queens, and the Bronx.
The Robert F. Smith Mobile MRI Unit will address the high incidence of prostate cancer in this patient population by raising awareness about this disease, setting up screening appointments, and scheduling follow-up visits when needed with Mount Sinai Health System urologists, according to Tewari, who noted that this program, "provides the necessary tools to detect cancer early and offers much-needed support to this community of patients."
The review also emphasized the importance of including African-American men with prostate cancer in clinical trials. The study authors noted that this has historically been a challenge and the statistics do not show an improvement in recent years. "There is an urgent need to plan novel recruitment techniques specifically targeting African-American patients, in order that they are fairly represented in future trials," they stated.
When it comes to addressing the survival disparities among African-American men with prostate cancer, Tewari believes this is a challenge that can be overcome with targeted efforts focused on prevention and early detection.
"This is a winnable battle," he noted. "We just need to find the cancer before it becomes unwinnable. Don't let it become metastatic. Don't let it become nodal. And, if we focus on that, we will have many more victories to come."
Catlin Nalley is a contributing writer.