African American men in the U.S. have the highest incidence of prostate cancer in the entire world! How can that be? The answers have eluded and frustrated researchers for years. We can say that progress in coming up with explanations has been slow for a lot of complex reasons. For one thing, not enough African American men have come forward to participate in studies that can save their lives. There is a growing body of evidence that suggests the problem is of genetic origin. And we also know for certain that there is a strong hereditary link in prostate cancer among males in black families.
That said, we have been told by many doctors that if a patient has minimum low risk cancer, he need not go for treatment and can safely elect active surveillance and not subject himself to outcomes like urinary incontinence and sexual dysfunction. That’s the position taken by the U.S. Preventive Task Force Service. So what does that say about African American men? If you are African American and have a low grade prostate cancer, is it safe for you to choose Expectant Management (active surveillance)? Well, the answer is “not so fast.”
Four researcher MD’s at Johns Hopkins—H. Ballentinen Carter, Edward Schaeffer, Ashley Ross and Debasish Sundi—set out to find out. They studied 1, 801 men—including 1,473 white men, 256 black men and 72 men of other races. They investigated pathologic and cancer-specific outcomes in these men and discovered striking results: African Americans had three times the number of advanced, aggressive forms of the disease with poorer outcomes compared to the others. Meaning, even though these men had been considered very low risk, their cancers turned out to be much more aggressive and extensive than the initial biopsies and physical exams suggested!
More than that, pathologist Jonathan Epstein found that the tumors in the African American men were bigger and of higher grade and much harder to find in the initial biopsy procedures. That in itself was significant. Because the disease was largely found at the top of the prostate, almost impossible to reach in the biopsy treatment. This finding suggests that there may be biologic differences in the prostates of African Americans and research must be done to find out why these large tumors develop in a location different from other men.
Bottom line: Because “very low risk” cancers in African American men seem different from other men in location and composition, Dr. Schaeffer believes we may need what he calls “race-specific” recommendations for the treatment of very low risk cancer. African American men, then, need to understand, says the Hopkins research team, that that if they decide on active surveillance, aggressive cancer may be missed.”