Is prostate cancer more common and more aggressive in African men?

The highest prostate cancer incidence and mortality rates in the world have been reported among Black African-American men (AAM) living in the United States of America. These rates are significantly higher for AAM compared to White (Caucasian) American men (CAM). However, prostate cancer is not the only malignancy which is more common in AAM compared to White American men or women. Although prostate cancer has the highest Black/White mortality ratio, it is not the only malignancy which has a higher mortality in AAM compared to CAM.     

Disease recurrence in black and white men undergoing radical prostatectomy for clinical stage T1-T2 prostate cancer

PURPOSE: The reported incidence and mortality of prostate cancer are higher among black than white men. Reasons for the disproportionate racial incidence of this disease are not known but most surveys suggest that increased mortality among black men is due to more advanced tumor stage at diagnosis. To determine if racial differences exist in men with similar stage disease we compared disease recurrence in black and white men who underwent radical prostatectomy for clinical stage T1-T2 prostate cancer. MATERIALS AND METHODS: We reviewed the records of all 257 white and 218 black men undergoing radical prostatectomy for clinical stage T1-T2 prostate cancer at the Louisiana State University Medical Center-Shreveport and the Overton-Brooks Veterans Affairs Medical Center between January 1990 and November 1998. Age, race, serum prostate specific antigen (PSA), ultrasound measured prostate volume, PSA density (PSA divided by prostate volume), histological features of the prostate biopsy, clinical stage, pathological stage, histological features of the radical prostatectomy specimen and disease recurrence were reviewed. RESULTS: Black men had significantly higher mean serum PSA and PSA density than white men (2-sided p = 0.005 and 0.03, respectively). There were no statistically significant differences by race in terms of patient age, prostate volume, clinical stage, biopsy Gleason score, pathological stage, positive pelvic lymph nodes, positive surgical margins or PSA recurrence rates. CONCLUSIONS: Black men with clinical stage T1-T2 prostate cancer who underwent radical prostatectomy had significantly higher serum PSA and PSA density than similarly treated white men. However, race appears to have no independent impact on pathological findings or disease recurrence in men with clinically localized prostate cancer treated with radical prostatectomy when the effects of differences in serum PSA are controlled.     

Clinical stage T1c prostate cancer: pathologic outcomes following radical prostatectomy in black and white men

BACKGROUND: The incidence of prostate cancer in black men is 50% to 70% higher than among age-matched white men. Black men have a twofold higher mortality rate and overall tend to have higher serum prostate-specific antigen (PSA) levels than white men. To determine whether racial differences exist in men whose prostate cancer was diagnosed based solely on an elevated serum PSA level, we compared clinical and pathologic features in black and white men undergoing radical prostatectomy (RP) for clinical stage T1c prostate cancer. METHODS: We used a prospectively collected database to identify all men undergoing RP for clinical T1c prostate cancer between July 1995 and October 2000. A total of 129 consecutive men (56 black men and 73 white men) were compared for age at diagnosis, serum PSA level, biopsy Gleason score, pathologic stage, RP specimen Gleason score, incidence of lymph node metastasis, and incidence of positive surgical margins. RESULTS: Statistically significant differences were not found by race in patients' ages, serum PSA levels, biopsy Gleason score, pathologic stage, incidence of lymph node metastases, or incidence of positive surgical margins. The RP specimen Gleason score was more heterogeneous in black men than white men (P=0.02). CONCLUSIONS: Racial differences in the incidence and mortality rate of prostate cancer are well known, but differences in the clinical and pathologic features between black and white men with prostate cancer identified solely based on an elevated serum PSA level with negative results on digital rectal examination (clinical stage T1c ) have been poorly studied. Our results suggest that men with clinical stage T1c prostate cancer have similar clinical and pathologic findings regardless of race. These results suggest that early-detection programs using serum PSA testing for prostate cancer in black men potentially can result in improvements in prostate cancer outcomes in this high-risk group.     

The prevalence of prostate cancer in Brazil is higher in Black men than in White men: systematic review and meta-analysis

Background: Black men have a higher incidence of prostate cancer compared with White men in several countries. In Brazil, most studies reported a similar prevalence of prostate cancer between Blacks and Whites as a result of the high race mixture of the population. Objective: To perform a systematic review with meta-analysis of the prevalence of prostate cancer in Black versus White, Brown versus White, and Black versus Brown Brazilian men. Design, Setting, and Participants: This systematic review included cohort, cross sectional and case-control studies comparing the prevalence of prostate cancer between races in Brazil. It was performed using an electronic search of references in bibliographic databases, and dissertations and theses databases from several Brazilian hospitals, universities, and schools of medicine. Meta-analysis was conducted using the RevMan software from the Cochrane Collaboration. To control for potential confounding variables, sensitivity analyses excluding case-control and cross sectional studies were performed. Measurements: The outcomes of interest included the number of participants, prevalence of prostate cancer, and odds ratio of cancer between Black and White men, Brown and White men, and Black and Brown men. Results and Limitations: Twelve studies approaching the prevalence of prostate cancer in Black or Brown vs. White men in Brazil were identifi ed, totalizing 41388 participants. The prevalence of prostate cancer was 9.6% in Black vs. 5.6% in White men (OR 1.58), 10.1% in Black vs. 6.7% in Brown men (OR 1.43), and 6.7% in Brown vs. 6.6% in White men (OR 1.14). Limitations of this review reflect the complexity and ambiguity in the defi nition of who is Black and who is not in such an heterogeneous population like the Brazilian people. Conclusions: This systematic review with meta-analysis demonstrates a higher prevalence of prostate cancer in Black men compared to White or Brown Brazilian men. The prevalence of prostate cancer is similar in Brown versus White men.     

Testis and prostate cancer incidence in ethnic groups in South East England

International variations in the incidence of testis and prostate cancer are well established. Data from the USA have also shown differences between White and Black men; however, there has been little work on ethnicity and cancer incidence in the UK, due to incomplete ethnicity information in cancer registries. The Hospital Episode Statistics (HES) dataset has more complete information on self-assigned ethnicity for inpatients of English NHS hospitals. Data on 194 590 male patients resident in South East England diagnosed with cancer between 1998 and 2003 were extracted from the Thames Cancer Registry (TCR). Of these, ethnicity information from HES was obtained for 123 507 (63%), ethnicity information from TCR was available for a further 5909 (3%), and no ethnicity was available for 65 174 (33%). Compared with 'All White' men, testis cancer incidence was significantly lower in Indian, Pakistani, Bangladeshi, Other Asian, Black Caribbean, Black African, Other Black and Chinese men. Prostate cancer incidence was significantly increased in Black Caribbean, Black African, Other Black, Indian, Pakistani, Mixed White and Black Caribbean and Mixed White and Black African groups compared with 'All White' men. Bangladeshi and Chinese men had a significantly decreased incidence of prostate cancer. The incidence of prostate cancer in Indian and Pakistani men showed convergence towards the rates in the white population, suggesting the existence of modifiable risk factors in these men. Most other variations in these data are consistent with international comparisons, and indicate that genetic variations in susceptibility are very influential.     

Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa

OBJECTIVES: To assess the feasibility of detecting early-stage prostate cancer in the primary healthcare setting, and to investigate whether there is a higher incidence of prostate cancer in Black African men. PATIENTS AND METHODS: The study was a collaboration with registrars in the authors' institutions and primary healthcare centres serving mainly a Black African or mixed ancestry (Coloured) population in the semi-urban Cape Town metropolitan area of South Africa. Men aged 50-70 years attending the clinics were counselled about prostate cancer and invited to have a digital rectal examination (DRE), serum prostate-specific antigen (PSA) assay and transrectal ultrasonography-guided sextant prostate biopsy if the DRE was clinically suspicious of malignancy or the serum PSA was > or = 4.0 ng/mL. An American Urological Association Symptom Index (AUA-SI) was obtained, and urine analysed using dipsticks. RESULTS: From May 2000 to November 2001, 660 men were assessed (mean age 59.4 years, range 30-82); 60.6% were Black African, 37.3% mixed (Coloured), 1.8% White (Caucasian) and 0.2% Asian (Indian). The mean (range) AUA-SI was 5.98 (0-35) in the whole group; the DRE was recorded as clinically suspicious of malignancy in 3.2%. The mean PSA was 20.39 (0.04-10 000) ng/mL in the whole group, but when two outliers (1865 and 10 000 ng/mL) were disregarded, it was 2.4 ng/mL. In Black patients the mean PSA was 31.8 (0.04-10 000) ng/mL, and without the outliers, 2.1 ng/mL; in Coloured patients it was 2.94 (0.05-50) ng/mL. The PSA was > or = 4.0 ng/mL in 9.6% of the whole group, in 7.8% of Black and in 13% of Coloured patients. Prostate biopsies were taken in 21 patients (3.2% of the whole group and a third of those with a PSA of > or = 4.0 ng/mL); in Black patients, biopsies were taken in 1.5% and 19.4%, respectively, and in Coloured patients in 6.1% and 46.9%, respectively. The prostate biopsy showed cancer in 43% of the whole group, in a third of Black and in 47% of Coloured patients; prostate cancer was detected in 1.4%, 0.5% and 2.8%, respectively. CONCLUSIONS: That prostate biopsies were obtained in only 19% of Black and in only 47% of Coloured men with a serum PSA of > or = 4.0 ng/mL is of concern. This indicates that there is a significant problem in getting men with an elevated serum PSA level to undergo a prostate biopsy in the primary healthcare setting in South Africa.     

Prostate cancer: an emerging threat to the health of aging men in Asia

The aim of this study was to determine and examine the possible reasons for the difference in prostate cancer incidence between Asian men and North American men by literature review. Data regarding cancer incidence and mortality were obtained from the database of the International Agency for Research on Cancer (IARC). A literature review was conducted by studying related articles published in peer-reviewed journals such as the The New England Journal of Medicine, Journal of Clinical Oncology, A Cancer Journal for Clinicians and Asian Journal of Andrology. To evaluate the early diagnosis and survival rates, the mortality-to-incidence rate ratio (MR/IR) was calculated from the IARC data. By comparing prostate cancer data between Asian men and North American men, we found that differences in the incidence rate and MR/IR could be attributed largely to a lack of annual prostate cancer screening with serum prostate-specific antigen (PSA) in most Asian countries. It is likely that PSA screening also contributes significantly to the differences in prostate cancer mortality rates. Prostate cancer has the highest incidence rate among five common malignancies in Asian Americans. However, the MR/IR ratio of prostate cancer is the lowest among cancers. These data seem to further support the usefulness of PSA screening, even though the percentage of low risk cancers is greater in prostate cancer than in other cancers. The low incidence rate of prostate cancer does not reflect the actual statistics of this disease in Asia. The data from limited institutions in many Asian countries seem to bias the true incidence and mortality rates. To improve this situation, incorporating PSA screening for prostate cancer, as well as constructing a nationwide cancer registration system, will be helpful.     

Explaining racial differences in prostate cancer in the United States: Sociology or biology?

Black men in the United States have the highest incidence and mortality from prostate cancer in the world. Even after adjusting for stage at diagnosis, black men have higher mortality rates than white men. Multiple reasons have been postulated to explain these findings including access to care, attitudes about care, socioeconomic and education differences, differences in type and aggressiveness of treatment, dietary, and genetic differences. While each reason may contribute to the higher incidence or higher mortality, likely combinations of reasons will best explain all the findings. Racial differences in socioeconomic status have been well established and we review the significance of these findings in relationship to prostate cancer. Also, with recent advances in the understanding of genetic variation in the human genome, in general, and in the genes involved in pathways relevant to prostate cancer biology, in particular, a number of genes with alleles which differ in frequency between black and white men have been proposed as a genetic cause or contributor to the increased prostate cancer risk in black men. However, the clinical significance of these genetic differences is not fully known. Finally, we conclude with some thoughts as to how to integrate the findings from sociological as well as biological studies and touch upon methods to reduce the disparate burden of prostate cancer among blacks in the United States.     

Rising prostate cancer rates in South Korea

BACKGROUND: Prostate cancer incidence and mortality rates in South Korea are relatively low, but rising steadily. METHODS: We examined age-standardized incidence and mortality trends of prostate cancer in South Korea to gain further insight into prostate cancer etiology. RESULTS: Although prostate cancer incidence has been low (7.9 per 100,000 man-years), it has increased up to 28.2% between 1996-1998 and 1999-2001. Prostate cancer mortality increased 12.7-fold over a 20-year period. Despite the increase in prostate cancer incidence and mortality rates, marked differences in rates remain for Koreans, Korean Americans, and Caucasian Americans. CONCLUSIONS: The rising rates of prostate cancer in South Korea cannot be attributed entirely to PSA screening due to the low PSA screening prevalence; this trend is most likely related to increased westernization among Koreans. Interdisciplinary epidemiological studies incorporating the collection of biological samples are needed to clarify the extent to which lifestyle and genetic factors contribute to the observed racial disparity.     

Racial origin is associated with poor awareness of prostate cancer in UK men, but can be increased by simple information

Prostate cancer is the second most common cause of cancer death in UK men. We have shown a higher incidence and disease stage in black British men (unpublished), however there is no evidence regarding their awareness of prostate cancer and screening. We assessed the level of prostate cancer awareness and attitudes in Black and White men in the UK, and to see if written information would modify awareness. Information was collected from two groups of 871 men without prostate cancer using a new, validated, prostate cancer awareness questionnaire. The first group was asked to fill in the questionnaire, whereas the second group was initially given printed information on prostate cancer and requested to fill in the questionnaire. Data were compared between the two ethnic groups using SPSS statistical package. Changes in knowledge and attitudes after providing prostate health education were analysed. There was a significantly lower response from Black men. In the first group, Black men were unaware of their increased risk of developing the disease and demonstrated poor knowledge about the symptoms of prostate cancer (P<0.001) and also more negative attitudes about its control and treatment (P<0.01). In the second group, there were significant improvements in knowledge, risk awareness and attitudes following targeted education: this was true for Black and White men. Although Black British men have a high risk of prostate cancer, their knowledge of the disease is poor. Simple education methods can significantly improve awareness and knowledge in both Black and White men.     

Prostate cancer incidence,stage at diagnosis,treatment and survival in ethnic groups in South‐East England

Study Type – Prevalence (prospective cohort)
Level of Evidence 1b

OBJECTIVES

To use self‐assigned ethnicity to examine patterns of incidence, stage, treatment and survival in patients with prostate cancer in South‐east England.

PATIENTS AND METHODS

Data on 36 961 men resident in South‐east England and diagnosed with prostate cancer between 1998 and 2003 were extracted from the Thames Cancer Registry. Ethnicity information was obtained from the Hospital Episode Statistics dataset, and matched to the cancer records. The ethnic groups examined were White (19 688), Black (1422) and Indian/Pakistani (397). Age‐standardized incidence rate ratios were calculated overall and for narrower age groups, with White men as the baseline group. Logistic regression was used to assess whether patients had a stage of disease recorded at diagnosis, if so whether it was metastatic, and to examine treatment received. To assess overall and prostate cancer‐specific survival (PCSS), Cox regression models were fitted, adjusting sequentially for age, socioeconomic status, treatment received and stage of disease at diagnosis.

RESULTS

Indian/Pakistani men had a lower age‐standardized rate than White men (rate ratio 0.69, 95% confidence interval 0.63–0.75), while Black men had a higher rate ratio (2.51, 2.30–2.73). There was no difference in the proportion of men diagnosed with metastatic disease in each ethnic group. There was variation in recorded surgery and hormone treatment. Indian/Pakistani men had better PCSS than White men (fully adjusted hazard ratio 0.76, P = 0.024). There was no difference in PCSS between Black and White men (hazard ratio 0.93, P = 0.238).

CONCLUSIONS

Black men had the highest incidence of prostate cancer, followed by White, then Indian/Pakistani men. The relative excess of prostate cancer in Black vs White men was strongly age‐dependent. Despite differences in recorded treatment, Indian/Pakistani men had better overall survival and PCSS. Black men also had better overall survival, and their PCSS was similar to that of White men. This might be due to access to the publicly funded National Health Service in the UK.     

Disease-free survival difference between African Americans and whites after radical prostatectomy for local prostate cancer: a multivariable analysis

Objectives. Age-adjusted mortality rates (per 100,000) for men with prostate cancer from 1991 through 1997 reported by the Surveillance, Epidemiology, and End Results national registry have consistently demonstrated that African-American men (AAM) have twice the death rate of white men (WM). However, there has been considerable controversy as to how this relates to progression-free survival among these men. In an attempt to address this controversy of localized prostate cancer, we report on a multivariable analysis of survival data of a large number of AAM and WM who underwent radical prostatectomy.Methods. The study cohort was composed of 791 men whose only prostate cancer treatment was radical prostatectomy performed between July 1990 and December 1999. The variables analyzed were age, preoperative prostate-specific antigen level, pathologic grade and stage, and race/ethnicity. Pathologic examination of all specimens was performed in a uniform manner according to an established protocol. Multivariable analysis based on Cox’s proportional hazards regression model was performed to assess whether a significant difference in progression-free survival time between AAM and WM persisted after controlling for the main effects of other prognostic factors.Results. The study cohort consisted of 229 AAM and 562 WM. Our results indicated that all variables, except age, had highly significant effects on progression-free survival, even in the presence of other predictors.Conclusions. The effects of age, preoperative serum prostate-specific antigen level, and pathologic grade and stage did not account for the racial disparity in progression-free survival among men diagnosed with clinically localized prostate cancer and treated with radical prostatectomy.     

Early diagnosis of prostate cancer in the Western Cape.

BACKGROUND: Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer. OBJECTIVES: In view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men. PATIENTS AND METHODS: Men aged 50-70 years were invited by means of media communications (newspaper and radio) to attend our prostate clinic for a free physical examination, including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) assay. If the DRE was clinically suspicious of malignancy and/or the serum PSA was > 4 ng/ml, the patient was appropriately counselled and referred for transrectal ultrasound (TRUS)-guided sextant prostate biopsy. RESULTS: In the period June 1997-September 1999 a total of 1,056 men attended the prostate clinic. Biopsies were indicated in 160 cases, and were obtained in 114 (71.3%, i.e. 10.8% of the entire cohort). Prostate cancer was detected on first biopsy in 3.5% of the entire group of men (in 35.9% of those with a clinically abnormal DRE, in 41.3% of those with a serum PSA > 4 ng/ml and in 88.6% of those with an abnormal DRE and serum PSA > 4 ng/ml. In the 37 men with prostate cancer, the clinical tumour stage was T1-2 in 83.8% and T3-4 in 16.2%. In the group of patients with clinical stage T1-2 tumours, the treatment was watchful waiting in 62.5% of cases, radiotherapy in 20.8% and radical prostatectomy in 16.7%. Analysis of the data according to race showed that in the group of 47 black men there was a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy, and a higher overall prostate cancer detection rate (8.5%). CONCLUSIONS: Our prostate cancer detection rate of 3.5% is slightly lower than that reported in larger studies (4.7%), which may be due to the fact that prostate biopsy was performed in only 71% of those who had an indication for biopsy. In the men diagnosed with clinically localised prostate cancer, potentially curative treatment was given in only 37.5% of cases. This compares unfavourably with the historical cohort of men seen at our oncology clinic, where 53% received potentially curative treatment, and a large European study where potentially curative treatment was given in 89% of cases. Our finding that black men had a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy and a higher overall detection rate of prostate cancer should be interpreted with caution, since black men comprised only 4.5% of our overall study cohort.     

Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates

ContextPrevious studies have reported significant variation in prostate cancer rates and trends mainly due to differences in detection practices, availability of treatment, and underlying genetic susceptibility.ObjectiveTo assess recent worldwide prostate cancer incidence, mortality rates, and trends using up-to-date incidence and mortality data.Evidence acquisitionWe present estimated age-standardized prostate cancer incidence and mortality rates by country and world regions for 2018 based on the GLOBOCAN database. We also examined rates and temporal trends for incidence (44 countries) and mortality (76 countries) based on data series from population-based registries.Evidence synthesisThe highest estimated incidence rates were found in Australia/New Zealand, Northern America, Western and Northern Europe, and the Caribbean, and the lowest rates were found in South-Central Asia, Northern Africa, and South-Eastern and Eastern Asia. The highest estimated mortality rates were found in the Caribbean (Barbados, Trinidad and Tobago, and Cuba), sub-Saharan Africa (South Africa), parts of former Soviet Union (Lithuania, Estonia, and Latvia), whereas the lowest rates were found in Asia (Thailand and Turkmenistan). Prostate cancer incidence rates during the most recent 5 yr declined (five countries) or stabilized (35 countries), after increasing for many years; in contrast, rates continued to increase for four countries in Eastern Europe and Asia. During the most recent 5 data years, mortality rates among the 76 countries examined increased (three countries), remained stable (59 countries), or decreased (14 countries).ConclusionsAs evident from available data, prostate cancer incidence and mortality rates have been on the decline or have stabilized recently in many countries, with decreases more pronounced in high-income countries. These trends may reflect a decline in prostate-specific antigen testing (incidence) and improvements in treatment (mortality).Patient summaryWe examined recent trends in prostate cancer incidence and mortality rates in 44 and 76 countries, respectively, and found that rates in most countries stabilized or decreased.     

Prostate-specific antigen as surrogate for characterizing prostate cancer subgroups

OBJECTIVE: To evaluate how serum prostate-specific antigen (PSA) levels in a population-based cohort of men with prostate cancer vary with age and intensity in the diagnostic activity and to describe the treatment selection processes associated with PSA level. MATERIAL AND METHODS: All men in the Swedish National Prostate Cancer Register diagnosed during 1996-1997 were included. In 1996 the register included 19 counties, covering 61% of the Swedish male population, and in 1997 21 counties with 79% of the Swedish male population. RESULTS: A total of 8328 men were registered. PSA levels were missing in 341 cases. With increasing PSA there was a shift towards more advanced and poorly differentiated tumours. PSA at diagnosis increased with age, with the exception of patients younger than 50 years who had higher PSA values. The mean logarithm of PSA correlated negatively with the percentage of localized tumours (p < 0.005) and the age-adjusted incidence (p < 0.05) in each respective county in 1997. PSA was higher in men receiving radiotherapy compared with those treated with radical prostatectomy as well as in the group treated with bilateral orchiectomy compared with those receiving GnRH-analogues. CONCLUSIONS: If PSA is used as a surrogate measure of extent of tumour volume in a population of prostate cancer patients, our findings indicate that age distribution and differences in incidence (possibly due to variation in diagnostic activity) should be taken into account. In our cohort there was a selection process, probably in part guided by PSA level, when choosing type of curative or palliative treatment.     

Mass screening for prostate cancer in patients with end-stage renal disease: a comparative study

OBJECTIVE: To determine the usefulness of prostate-specific antigen (PSA) screening for prostate cancer in patients with end-stage renal disease (ESRD), as although serum PSA is effective in the early detection of this cancer in the general population, there are few reports of its utility in patients with ESRD. PATIENTS AND METHODS: Blood samples were obtained for PSA screening from April 2002 to September 2003; 1250 men with ESRD aged >50 years were compared with 1007 healthy control men aged >55 years, all in Kumamoto Prefecture, Japan. All men with a serum PSA level of >4.0 ng/mL were categorized as PSA-positive and were further assessed, including a prostate biopsy. RESULTS: There was a statistically significantly greater increase in PSA level with age in the ESRD group than in the healthy controls. The rate of cancer detection among men with a PSA level of >10 ng/mL was significantly higher in patients with ESRD than in healthy controls. Thirteen patients with ESRD and five healthy control men were finally diagnosed with prostate cancer. CONCLUSION: The serum PSA level was slightly higher and the incidence of prostate cancer at higher PSA levels appeared to be greater in men with ESRD than in healthy controls. The findings of this large study suggest that PSA screening is useful for the diagnosis of prostate cancer in these patients.     

The risk of prostate cancer amongst South Asian men in southern England: the PROCESS cohort study

OBJECTIVE

To reinvestigate whether South Asian men in the UK are at lower risk of being diagnosed with prostate cancer in a UK‐based retrospective cohort study and to examine possible reasons that may explain this.

PATIENTS AND METHODS

The catchment areas were predefined in four areas of southern England, and age‐ and race‐specific populations for those areas taken from census data. Cases were ascertained through review of multiple hospital sources, while race, other demographic factors, and medical history were determined using questionnaires sent to the men, hospital records review and death certificates. The South Asian group included men of Indian, Bangladeshi and Pakistani origin.

RESULTS

There was modest evidence of lower prostate cancer rates in South Asian men compared with their White neighbours (age‐adjusted rate ratio 0.81; 95% confidence interval 0.65–1.00). This difference did not reflect less use of prostate‐specific antigen (PSA) testing or differences in clinical features at presentation.

CONCLUSION

This study provides evidence of a lower incidence of prostate cancer amongst South Asian men living in England, in comparison with their White counterparts. If anything, South Asian men presented with clinical features of earlier disease suggesting that the reduced risk is unlikely to be an artefact of poorer access to health care.     

Vitamin D receptor gene polymorphisms and disease free survival after radical prostatectomy

BACKGROUND: Vitamin D has been linked with prostate cancer risk in epidemiologic studies and has antiproliferative, prodifferentiation, and antimetastatic properties in experimental systems. Its hormonal activity is mediated by the vitamin D receptor. We investigated whether germ-line genetic variation in the vitamin D receptor impacts progression of prostate cancer after radical prostatectomy. METHODS: We analyzed BsmI and TaqI polymorphisms using archived specimens from a large series of radical prostatectomy patients at a single institution. Our series included 428 white men (WM) and 310 African-American men (AAM) who were carefully and uniformly staged and followed for 5-10 years. RESULTS: The distribution of polymorphisms varied between WM and AAM. There was little association between genotype and extent of disease at diagnosis, Gleason score, preoperative PSA, or recurrence overall. Among WM with locally advanced disease, however, the BsmI B allele protected against recurrence in models examining gene dose (P = 0.04) and dominant effects (P = 0.05). CONCLUSIONS: Overall vitamin D receptor polymorphisms did not predict pathologic features of prostate cancer but may impact on risk of recurrence among men in certain risk groups. Analysis of polymorphisms may provide clues about the mechanisms through which vitamin D exerts its inhibitory effects on prostate cancer in vivo in men.     

C-reactive protein is significantly associated with prostate-specific antigen and metastatic disease in prostate cancer

OBJECTIVE: To further analyse the relationship of c-reactive protein (CRP) levels to prostate cancer, by measuring CRP in men with prostate cancer and benign prostatic hypertrophy (BPH), as chronic inflammation has long been linked to cancers with an infectious cause and CRP is a nonspecific marker for inflammation, associated with prostate cancer incidence and progression. PATIENTS AND METHODS: Data from 114 men, most of whom had had radioactive seeds implanted, were evaluated from November 1990 to April 2002. In addition, 27 men were included who had biopsy-confirmed BPH. CRP was assessed with an automated chemiluminometric high-sensitivity assay kit. RESULTS: There was no significant difference in CRP levels in men with localized prostate cancer or BPH but levels were significantly higher in men with bone metastases. There was also a significant correlation of CRP level with prostate-specific antigen (PSA) in those with cancer. Because PSA is correlated with disease stage, multiple linear regression was used with CRP as the dependent variable, and PSA and disease stage as independent variables. The regression was significant overall (P < 0.001) and the effect of disease stage on CRP (P < 0.001) was independent of the effect of PSA level (P = 0.001). CONCLUSION: The strong association of CRP with PSA, independent of tumour stage, suggests that inflammation might be fundamental in prostate cancer, and that chronic inflammation may be a legitimate target for prostate cancer chemoprevention and treatment.