African Americans May Benefit from Early Prostate Cancer Screening and Treatment

Despite More Aggressive Disease and Conflicting Results of Previous Studies

January 23, 1999. African American men are more likely to get prostate cancer and more likely to die of it than any other ethnic group. Yet a recent study found that African-American and white prostate cancer patients who underwent radical prostatectomy (surgical removal of the gland) had similar outcomes — except when biologically aggressive disease was present.
     Although both groups of men had their prostates removed, if disease was aggressive African Americans fared worse than whites. Does this mean it is not worth taking steps to find prostate cancer early in African American men? Not at all, say the study's authors. Early prostate cancer screening may be as beneficial for African Americans as for the general population.
     What's true, they note, is that recent studies comparing radical prostatectomy’s effectiveness in black and white men have provided conflicting conclusions. For patients who have localized prostate cancer (organ-confined cancer, which has not spread), radical prostatectomy can aid disease-free survival. In one of these earlier studies, though, researchers found that cancer recurrence rates were higher for black men despite standard surgical procedures and even though the clinical stage of their cancer was not more advanced. This suggested that (for some unknown reason) black men might not benefit from early detection programs.
     These earlier studies, while classifying patients by stage of disease, did not look at the aggressiveness of a given patient's cancer. Now a study reported in Dec 1, 1998 issue of the has tested the theory that when classified for pathologic (aggressive) extent of local (organ-confined) disease, African American and white males treated with radical prostatectomy would experience equivalent outcomes.
     Of the study’s 1,319 North Carolina men who underwent radical prostatectomy between January 1970 and December 1996, 115 were African American and 1,204 were white. Researchers examined patients’ prostate specific antigen (PSA)-failure and cancer-associated death rates. PSA is a blood test for prostate cancer, and PSA failure signals disease progression.
     Race did not play a role in the outcome of patients with organ- or specimen-confined tumors. But compared with white males, African American males (AAM) whose prostate surgical margins (tissue surrounding a removed tumor) contained cancer seemed to have greater biological aggressiveness of residual disease, a higher recurrence rate of disease, and lower survival rates even after radical prostatectomy.
     Still, "[precisely because] local extent of disease impacts on PSA failure and survival, and because the disease appears to present earlier in AAM, the [African American male] population may benefit from early detection programs," explains study coauthor Dr. David F. Paulson, M.D., Duke University Medical Center, Durham, North Carolina.
     This study’s results agree with previous findings that prostate cancer is more virulent in African American males. There is an ongoing debate as to whether or not the cause of such virulence is biologic and/or socioeconomic. The current study’s results indicate that where where disease extent is similarly classified among men who have organ- or specimen-confined disease, radical prostatectomy can offer African Americans and whites equivalent cancer-associated survival and PSA failure rates.
      "[Our] observations argue strongly for PSA detection programs in AAM" says Dr. Paulson.

Surgical Control of Clinically Localized Prostate Carcinoma Is Equivalent in African-American and White Males, Christopher E. Iselin, M.D., James W. Box, M.S., Robin T. Vollmer, M.D., Lester J. Layfield, M.D., Judith E. Robertson, C.T.R., David F. Paulson, M.D. CANCER 1998; 83:11, pp. 2353-60. CANCER is published for the American Cancer Society by John Wiley & Sons, Inc.