Race, Ethnicity, Marital Status, Literacy, and Prostate Cancer Outcomes in the United States

Epidemiology

African-Americans (AA) have a 25% greater cancer mortality rate compared to Caucasians, and prostate cancer is a significant contributor to the overall cancer mortality gap in men. There will be an estimated 220,800 new cases of prostate cancer in 2015, with AA men having the highest incidence of prostate cancer among men in the United States. Asian-American/Pacific Islanders have the lowest incidence, whereas Hispanic men have an incidence rate slightly lower than non-Hispanic Caucasians (124.2 vs. 138.6 per 100,000, respectively). AA men had an almost 2.4 × rate of mortality from prostate cancer compared to Caucasian men from 2006 to 2010, a gap that has not narrowed significantly within the last 20 years. In order to elucidate the source of this glaring disparity in AA men, it is important to examine variance in stage at diagnosis and treatment, as well as the potential impact of genetic differences and social factors.

Prostate cancer disparity in African-American men

AA men are diagnosed with prostate cancer at an earlier age compared to Caucasian men. Data from the Surveillance, Epidemiology, and End Results (SEER) Program 1996–2002 show that AA men are approximately 3 years younger at the time of prostate cancer diagnosis and are significantly at higher risk (relative risk 1.93) of prostate cancer diagnosis prior to age 45. These data are in line with the findings of Powell et al., who examined autopsy specimens in men who died from nonprostate cancer causes, and compared them with prostatectomy specimens from their institution and Detroit SEER data. Their results suggest that while subclinical prostate cancer develops at a similar age among young AA and Caucasian men, the higher rate of metastatic disease and greater tumor volume among AA in the same geographical area are the result of a faster growth rate and/or earlier transformation to aggressive disease. Data from SEER and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE ^TM ) show that AA men present with higher-grade and higher-stage disease at the time of diagnosis. Differences in screening patterns likely contribute to differences in stage at diagnosis, both of which are significant contributors to higher prostate cancer-specific mortality in men.

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