by Peter Carson

Problems with prostate

Does race play a part in cancer risk?

Problems with prostate
Does race play a part in cancer risk?

Black men with very low-risk prostate cancer may not do as well with a wait-and-see treatment approach as white men, scientists reveal.

Researchers found that black men who had their prostates removed soon after being diagnosed with low-risk cancer were more likely to have the severity of their cancer upgraded based on a second assessment, compared with their white counterparts.

"It’s known that outcomes for African Americans with prostate cancer are not good. That’s a known fact," says Dr Edward Schaeffer, the study’s senior author, at Johns Hopkins Hospital in Baltimore.

The American Cancer Society estimates about one in six US men will be diagnosed with prostate cancer during his lifetime, and one in 36 will die of the disease.

About 20% of cancers are very low risk and it’s recommended that doctors use "active surveillance" among men who are expected to live for less than 20 years, writes Dr Schaeffer.

With active surveillance, the prostate cancer is closely monitored but not treated. That allows men to avoid the potential side effects of radiation and surgery, such as incontinence and impotence. It also gives doctors a chance to intervene if the cancer worsens.

But the data used to advise doctors on who the best candidates are for active surveillance are based on studies that included mostly white men. Therefore, the guidelines may not apply to black men, who are known to have worse prostate cancer outcomes, researchers say.

For the new study, Dr Schaeffer and his colleagues analysed data on 256 black men, 1 473 white men and 72 men of other races who were diagnosed with very low-risk prostate cancer.

The men all had their prostates surgically removed at Johns Hopkins Hospital soon after they were diagnosed.

The researchers then looked at what doctors actually found when they removed the men’s prostates and whether there were any differences in cancer characteristics between black men and white men.

Overall, about 27% of black men ended up having worse cancers than doctors originally thought, compared with about 14% of white men.

Researchers also found more black men had cancers that were likely to return after they were removed.

What’s more, additional research from Dr Schaeffer and his colleagues, found black men tend to have larger tumours located in areas of the prostate that are not easily accessible for doctors to biopsy.

"If you have an African American man with very low-risk prostate cancer, our recommendation at this time is that they strongly consider an MRI of their prostate (to look for these tumours)," Dr Schaeffer says.



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