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Prostate Cancer in African American Men

Compared to white men, the risk of getting prostate cancer in an African American man is 60% higher (relative risk 1.6) and the risk of dying of this disease is more than twice as high (relative risk 2.3). So one of every 5 African American men will be diagnosed with prostate cancer (19%) and 5% will die of this disease (go here or here).

African American men should consider starting screening at an earlier age (40y or 45y) and consider getting a biopsy if the PSA rises above 2.5

If African American men are encouraged to get screening and come in early for treatment... there is no reason their outcome should be that much worse than white men. We reviewed our experience with prostate cancer at Bayfront Hospital in St. Petersburg, Florida and found that the stage distribution was similar to whites, the age was younger, but survival was similar.

Even with good and early treatment, there are studies in the literature which suggest that the cancer may more aggressive in black men ... see the study below from MD Anderson.


African-American men with nonpalpable prostate cancer exhibit greater tumor volume than matched white men


Ricardo F. Sanchez-Ortiz, MD Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Cancer 2006;107:75
Although prostate cancer (PC) mortality disproportionately affects African-American (AA) men, limited data exist comparing the pathologic characteristics of white and AA patients with nonpalpable PC (clinical stage T1c).
The authors reviewed the radical prostatectomy (RP) specimens from 37 consecutive AA men with clinical stage T1c PC and 35 white men who were matched for age, clinical stage, serum prostate-specific antigen (PSA) level, year of surgery, prostate weight, and prostate biopsy strategy. Pathologic characteristics were compared after mapping tumor foci and calculating tumor volumes by using computer software.
For AA men, the median age (57.7 years), mean serum PSA level (9.3 ng/mL), mean prostate weight (43 g), and biopsy strategy (73% sextant) were matched with the cohort of 35 white men (median age, 57.1 years; mean PSA, 9.3 ng/mL;, mean prostate weight, 43 g; biopsy strategy, 66% sextant). Despite similar biopsy characteristics between the 2 groups (Gleason score  7 in 43% of AA men vs. 37% of white men), AA men exhibited significantly higher prostatectomy Gleason scores ( 7 in 76% of AA men vs. 34% of white men; P = .01). AA men also had a higher mean tumor volume (1.82 cm3 vs. 0.72 cm3; P = .001) and had 2.8 times more tumor per ng/mL of serum PSA (0.22 cm3 per ng/mL vs. 0.079 cm3 per ng/mL; P = .001).

CONCLUSIONS
Compared with a cohort of white men with similar clinical features at the time of biopsy, AA men with nonpalpable PC had higher prostatectomy Gleason scores, greater cancer volume, and greater tumor volume per ng/mL of serum PSA. These data provide additional support for the concept of early PC detection using a serum PSA threshold of 2.5 ng/mL for biopsy among AA men. Cancer 2006.