Inner-city black men face higher risk of prostate cancer

March 28, 2006

GAINESVILLE, Fla. — Inner-city black men are almost twice as likely to be diagnosed with prostate cancer as whites and are four times more likely to be in advanced stages of the disease at diagnosis, according to a new study led by University of Florida researchers.

The findings, to be published in the April issue of the Journal of the National Medical Association, call attention to the need to screen these men early — beginning at age 45 instead of 50 — and to offer them ongoing prostate cancer education, UF researchers report.

Prostate cancer remains the second-most-commonly diagnosed cancer and the second-most-common cause of cancer deaths in American men over age 45. Even so, prostate cancer mortality rates in the United States have been steadily declining during the past 10 years, thanks to serum prostate-specific antigen, or PSA, blood tests and improved treatments.

But the researchers found a different situation for inner-city men in Jacksonville, Fla.

“It all came about when we noticed that several patients we screened in Jacksonville were presenting with more advanced disease than what we had seen in similarly sized settings — namely Houston and Winston-Salem,” said Dr. Charles Rosser, the study’s senior author and an assistant professor of urology at the University of Florida – Jacksonville. “Patients who presented in Houston and Winston-Salem had already been screened so thoroughly that they presented with a lot earlier disease than what we saw here. We wanted to know why Jacksonville’s numbers were so much higher.”

Although several variables may be involved, Rosser thinks the cause is a lack of prostate cancer screening and ongoing education in inner-city Jacksonville.

“Other communities our size have had fairly large screening initiatives – first directed to the general community and then directed to minorities in the inner city,” he said. “Here in Jacksonville we didn’t have anything like that until 2003, when UF College of Medicine–Jacksonville urologists, in partnership with the Duval County Health Department, began offering free screenings at UF’s affiliated hospital, Shands Jacksonville.”

Using the data from these screenings, the seven-member research team set out to assess the detection rate of prostate cancer and disease stage at diagnosis. Researchers collected and analyzed clinical and pathological data from the biopsies of 368 men — 52 percent white, 42 percent black, 5 percent Hispanic and 1 percent Asian. Because of the small numbers, Hispanics and Asians were excluded for study purposes.

Researchers then reviewed clinic and hospital records for several key outcomes, including cancer incidence, tumor stage (if and how far the cancer has spread) and tumor grade (how far the cells have changed from normal to abnormal on a 1-to-5 scale, with grade 1 being the least aggressive).

Still, the researchers were surprised to find these men were four times as likely to have advanced cancer, Rosser said.

“The chance of usually presenting with advanced disease is maybe 5 percent nationwide,” he said. “Our study sample showed 16 percent for blacks and 3.8 percent for whites — a statistically significant finding.”

When patients don’t begin treatment until cancer is advanced, the cure rate drops dramatically.

“Once the cancer has spread beyond the prostate, we’re not looking to cure the disease — we’re just looking to slow its growth,” Rosser said. “Our findings strongly suggest that, despite two decades of increasing emphasis on prostate cancer screening and detection in the United States, such programs may not be reaching or having the desired effect on underserved inner-city populations, especially blacks.”

Annual screenings should include the PSA blood test and an exam, with biopsy and further examination recommended for a PSA level above 4.0, Rosser said.

UF’s research is valuable and confirms what others have published, said Dr. Isaac Powell, professor of urology at Wayne State University and Karmanos Cancer Institute, who has been studying prostate cancer in Detroit for 16 years. “Not only do black men have a higher incidence of the disease but their death rate is two to three times higher than white men,” he said. “Our data suggest the disease may be growing faster among blacks than whites, so we’re studying genetics, diet, prostatitis and health-seeking behavior to try to explain these differences.”

Education is key for these men, according to Rosser.

“Of course, we need to stress the importance of annual screenings, but we also need to let them know why they’re being screened and explain that, as black men, statistically they’re at higher risk for the disease,” he said. “Education must go hand in hand with screening.”

The study identifies a disparity in prostate cancer screening and detection among men of differing social strata that is especially worrisome at a time when the underserved — especially blacks — stand to benefit most from such programs, Rosser said.

“We need to rectify this disparity by establishing in underserved inner-city communities across the United States large-scale and innovative screening programs to educate men about prostate cancer, screen them for the disease and assist them in obtaining follow-up care,” he said.