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Prostate Cancer In African American Males

Famous African American Men Fighting For Prostate Cancer Awareness After Diagnosis

African-American Men and Prostate Cancer

During Black History Month, we acknowledge the courage and tenacity of famous African American prostate cancer survivors and applaud their efforts to raise awareness on a world-wide platform during their illustrious careers.

As many as one in eight men in the U.S. will be diagnosed with prostate cancer, that is one new diagnosis every 2.1 minutes, making it the second most common cancer among men. Each year in the U.S., more than 30,000 men die of this disease. These statistics increase for African American men how have a higher chance than most other men to be diagnosed with prostate cancer. Key risk factors for prostate cancer include age, race and family history. Unfortunately, differences in access to care and in care practices suggest not all patients receive optimal care. This may be particularly true for those with advanced disease and those in underserved or otherwise vulnerable communities.

The men highlighted below have made their fight public to raise awareness about the importance of early detection and encourage men to know their risk and talk to their doctor about getting tested.

Shortage Of Black Male Doctors Having A Public Health Impact

Black men have similar outcomes to white men once theyre diagnosed with prostate cancer, when you account for differences in access to health care and receiving guideline-recommended treatment, said lead study author Dr. Daniel Spratt, associate professor and vice chair of radiation oncology at the University of Michigan. In fact, black men, on average, had better outcomes than white men, when looking at patients who enrolled on clinical trials.

This data suggests that although on the population level, more black men die from prostate cancer than white men this disparity is largely, if not entirely, driven by social constructs and even systematic racial disparities in our country, Spratt told NBC News. These include less access to health care, insurance, and appropriate and timely treatment.

The University of Michigan researchers led by Spratt and Dr. Robert Dess looked at data from 306,100 men 54,840 black men ages 59 to 71 from the Veterans Affairs system and four other clinical trials. When the researchers compared black and white men of similar age, socioeconomic status, and tumor characteristics, such as prostate specific antigen levels, stage and grade of cancer all of which predict the cancers aggressiveness they found that black men had comparable rates of death to white men, when they had similar access to care and standardized treatment.

The new findings underscore the need for equal access to care and treatment.

African American Men Respond Better To Treatments For Advanced Prostate Cancer In Clinical Trials

  • By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Racial differences have long been evident in prostate cancer statistics. In particular, African American men are diagnosed with prostate cancer more often than white men, and theyre also nearly twice as likely to die of the disease.

But new research also shows that African American men who receive the most advanced treatments for late-stage prostate cancer can live at least as long or even longer than their Caucasian counterparts.

Why is this the case? Scientists are searching for an explanation. The fact that African American men have better survival is of huge research interest, said Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center in Los Angeles. If we can figure this out, well obtain key insights into the factors driving survival in late-stage prostate cancer. And that in turn will help spur better treatments for all men regardless of race.

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Black Men Both Get And Die From Prostate Cancer At A Higher Rate The Reasons Are Complex And Unclear

Black men are 50% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease, Dr. Kantoff says.

It is difficult to untangle the various factors that might affect the risk and outcome of prostate cancer, Dr. Kantoff explains. Prostate cancer in Blacks tends to have biological characteristics associated with more aggressive disease, he says. There is evidence suggesting that this is partly related to inherited genetic factors.

He points out that in addition to differences in tumor biology, the higher risk may be tied to disparities in environment and behavior. This could include social stress or more exposure to cancer-causing pollutants. Smoking, poor diet, and lack of exercise, which can cause obesity, may also have effects. Disparities in outcome could be affected by differences in when the cancer is diagnosed and how the men are treated after diagnosis.

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Whats Being Done To Raise Awareness About This Issue

Im happy to report that much is being done to raise awareness of this issue.

The 14th annual Prostate Health Education Network Summit was held September 13-14, 2018 in Washington D.C. on Capitol Hill. The summit brings together survivors of prostate cancer, leaders from medicine, research and government industry to discuss policy and medical issues about prostate cancer specifically in African- American men. Currently this Summit is working on boosting African-American male participation in prostate cancer clinical trials.

The Impact Of Behavioural And Socio

Socio-economic status can be a significant issue relating to health-seeking behaviours. AAs are reported to be more likely to have a lower educational attainment, employment, and adequate health-care insurance, which may contribute to limited access to screening and health choices . Black men within the UK were also more likely to be of a less affluent socioeconomic status , yet this had no effect on health access due to the widely accessible health-care structure of the NHS.

A well-designed meta-analysis of 48 studies concluded that health-care access, PSA screening, and comorbidities were not associated with a high risk of prostate cancer and mortality in black men . AA men were offered fewer treatment options, or would opt for watchful waiting due to fear of side effects associated with curative treatment, resulting in a high likelihood of significant disease progression . Black men who opt for curative treatment were shown to be three times more likely to choose external beam radiotherapy over radical surgery .

Jack et al present findings from the UK Thames Cancer Registry reporting black and South Asian men were less likely to choose radical surgery or hormones compared to white men, however, the receipt of radiotherapy was similar amongst all ethnic groups .

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Treatment Delivery And Response

âWe know that Black men have delayed diagnoses — and, therefore, treatment,â Mucci says. âThey also tend to get different types of treatment, and their access to care is different,â she says. Yamoah cautions that âWeâre not asking doctors to treat Black men with prostate cancer differently ⦠we need to treat based on their biology.â

We still donât know whether certain prostate cancer treatments work as well for Black men, Mucci says. But Mahal points out that âIn radiation trials where patients had the same disease status and equal access to care, Black men actually had a better prostate cancer survival rate than others.â He adds that their overall death rates were higher, but that this may have been due to having more than one illness.

Black Men Should Be Screened For Prostate Cancer More Proactively

Complementary medicine, diet and African American Men with Prostate Cancer

Given the higher risk of developing and dying from prostate cancer, Black men are more likely to be saved by screening, Dr. Kantoff says. The main prostate cancer screening tests are a digital rectal exam, in which a doctor checks for swelling and inflammation, and a PSA test, which measures the level of prostate specific antigen in the blood.

Black men are 50% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease, says Philip Kantoff.

Dr. Kantoff explains that a calculation commonly used in the context of screening is: How many men need to be screened in order to save one life? Theoretically, he says, among Black men, that number should be lower. Screening guidelines have been based on studies that included very few Blacks, so they may underestimate the screening benefit for this group. Overall, Blacks may need earlier and more frequent screening than the general guidelines would suggest.

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Psa Levels Are Higher Among African Americans

In general, African American men present with higher PSA values when compared to white men . Several studies have shown that African American men with nonmetastatic prostate cancer have higher serum PSA levels at diagnosis than Caucasian men with nonmetastatic prostate cancer, suggesting that perhaps African Americans have a higher tumor cell burden . Furthermore, African American men with or without evidence for prostate cancer have a higher PSA density than Caucasians . However, the differences between African Americans and Caucasians in PSA velocity is controversial . In one study, Caucasians had higher PSA velocities than African American men of a similar age, despite the fact that African Americans had a higher baseline PSA value, age-for-age . This finding could be attributed to laboratory test access as perhaps African American men may have had fewer PSA tests over time, thus impacting their velocity score despite higher individual PSA values. Another study, reported that PSA velocity is higher in Caucasians only in the 6069 age bracket, whereas in the 4049 age group, PSA velocity is higher in African Americans. Nonetheless, despite the fact that PSA levels, density, and velocity appear different in African-American men compared to Caucasians, the USPSTF has issued guidelines that are not race specific.

Im A Black Man Under 45 What Can I Do

When youre 45, speak to your GP about your risk of prostate cancer.

If youre aged 40-44, you could think about asking for a PSA test to help work out your risk of getting prostate cancer in the future. The aim of a baseline test is not to help diagnose prostate cancer, but to help work out your risk of getting prostate cancer in the future.

There is some research suggesting that your PSA level in your 40s could be used to predict how likely you are to get prostate cancer, or fast-growing prostate cancer, later in life. If the test suggests youre at higher risk, you and your doctor may decide to do regular PSA tests. This might be a good way to spot any changes in your PSA level that might suggest prostate cancer.

However, we dont yet know exactly what PSA level in your 40s would show an increased risk of prostate cancer, or how often you should have more tests. Because of this, baseline testing isnt very common in the UK.

Your GP doesnt have to give you a baseline PSA test. If your GP wont give you a test, read about what you can do.

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African American Males More Likely To Die From Prostate Cancer

Health care disparities remain a problem some experts say

NEW ORLEANS – Prostate cancer is a serious problem in the U.S., including in Louisiana and African Americans are more likely to die from the disease.

Men are uniquely at risk for that type of cancer.

William Robinson founded the Black Mens Health Initiative after something his father experienced.

The way I found out about it is that at age 40 my dad who had been partially paralyzed started urinating blood and it was because his prostate had enlarged so much it was squeezing off his urethra, said Robinson.

That led Robinson to get checked out himself and to create the Black Mens Health Initiative where he serves as director.

I was fine, but I said given what my dad had experienced which really scared me I wanted to make sure that there was an effort, we put together an effort to go out and educate black men about their risk for prostate cancer, he said.

Dr. Pia Chowdry of the Hematology/Oncology section at LSU Health New Orleans shared her expertise on prostate cancer.

Prostate cancer is a type of cancer that develops in the prostate gland, which is this small, walnut-sized gland found in men that basically produces seminal fluid and helps transport sperm, said Chowdry.

She also spoke about the incidence of that type of cancer in the nation and in Louisiana.

And among African American males the incidence of the disease is worse.

She said lifestyle and environment can be factors as well.

Robinsons agrees.

A Larger Conversation On Health Disparities

Balding in African

Factors leading to health disparities for prostate cancer in African Americans include stress, income, lifestyle and poor diet. Biological differences and medical access also contribute.

Prostate cancer is diagnosed in about 164,000 American men every year. It kills about 29,000 a year, according to the American Cancer Society. And African American men have about a 15 percent chance of developing prostate cancer in their lifetimes, compared to about a 10 percent chance for white men, according to the National Institutes of Health.

Previous studies most notably the SEER trial have shown that African American men have the highest rates of new prostate cancer diagnoses and are twice as likely to die from the disease as white men. Although this disparity is nothing new, researchers have been unable to provide concrete answers as to why it exists.

While the new JAMA Oncology study does not answer the question of why black men develop prostate cancer more often than white men, it does highlight several factors that black men should be aware of when addressing their health.

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Healthprostate Screening: Should You Or Shouldn’t You

But another factor, Mahal said, is that doctors may provide biased treatment to black men, based on the idea that they inherently have more aggressive cancers.

Mahal published a separate study Wednesday in the New England Journal of Medicine that looked at the increasing trend of conservative management for low-risk prostate cancer. That study noted that, while conservative management for prostate cancer has increased for both black and white men, doctors offer the approach to black men disproportionately less often than white men.

Conservative management of low-risk prostate cancer through either active surveillance or watchful waiting has been increasingly used as an alternative to radiation or . However, this approach may be underused among black men, because they are generally underrepresented in clinical trials and are thought to have more aggressive cancers, Mahal said.

A Surprising Finding About Low

Overall, few men in the specialized SEER database died from prostate cancer, they found. But there were differences by grade and race.

In particular, African Americans were more likely to have died from low-grade prostate cancer than men of other races . By contrast, the rates of death from high-grade disease were similar among African Americans and of men of other races .

The investigators found similar results when they analyzed data from the main SEER database, which includes information on more than 400,000 men with prostate cancer who were followed for a median of more than 5 years.

In that analysis, a greater proportion of African American men than men of other races had died from low-grade prostate cancer 12 years after diagnosis . By comparison, the 12-year death rate from higher-grade prostate cancer was similar among African American men and men of other races .

We were surprised to find that disparities were greatest in low-grade disease, Dr. Huang noted, because they had expected it to be similar across all grades.

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Screening Active Surveillance And Biopsies

Early detection is important for everyone with prostate cancer. But Mucci says Black men face unique barriers when it comes to diagnosis.

One hurdle for Black men is lack of access to insurance and medical care, Yamoah says. Another is the fact that their tumors tend to start sooner and spread faster. Even when their cancer is the slow-growing type, Black men have twice the risk of death as that of other races, although itâs still small.

Screening can save more Black lives than it can for those at lower risk. When prostate-specific antigen screening tests began in the 1990s, death rates fell the most for Black men. Early — and frequent — screening is critical because of the strong link between midlife PSA levels and the risk for Black men of getting aggressive prostate cancer.

These are the American Cancer Society guidelines for higher-risk groups:

  • Start PSA at age 45 for African Americans and men who have a father or brother who had prostate cancer when they were younger than age 65.
  • Start PSA at age 40 for men with more than one close relative who had prostate cancer when they were younger than age 65.

For white men whose PSA levels are above normal, doctors usually choose active surveillance, or âwatchful waiting.â With repeat PSA tests, rectal exams, and biopsies, they can check for signs that the cancer is growing. This approach isnât used as much with Black men because the risks are much higher.

African Americans And Prostate Cancer

African Americans and Prostate Cancer | Ask a Prostate Oncologist, Mark Scholz, MD

African American men are at an increased risk for developing prostate cancer over white men and other men of color. One in seven African American men will develop prostate cancer in his lifetime. Overall, African American men are 1.8 times more likely to be diagnosed withand 2.2 times more likely to die fromprostate cancer than white men. African American men are also slightly more likely than white men to be diagnosed with advanced disease.

Fortunately, the racial divide for prostate cancer outcomes is narrowing. Overall, the five-year relative survival rate for African American men diagnosed with prostate cancer is 97%, which means that if an African American man is diagnosed with prostate cancer today, at any stage, there is a 97% chance he will be alive in five years. When the disease is caught early, this rate increases to nearly 100%.

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