Study launched to understand prostate cancer in African Americans
Study launched to understand prostate cancer in African Americans
A $26.5 million study has launched to study biological and non-biological factors associated with aggressive prostate cancer in African American men.
The study, called RESPOND — Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers and Social Stress — aims to better understand why African American men disproportionally experience the aggressive disease compared with men of other racial and ethnic groups.
African American men have about a 15 percent chance of developing prostate cancer in their lifetimes, compared to about a 10 percent chance for white men. The risk of dying from prostate cancer for African American men is about 4 percent compared to about 2 percent for white men.
“Understanding why African-American men are more likely to be diagnosed with aggressive prostate cancer than men of other racial and ethnic groups is a critical, unanswered question in cancer disparities research,” said NCI Director Ned Sharpless, M.D. “This large, collaborative study can help the cancer research community better understand and address these disparities.”
The investigators aim to enroll 10,000 African American men with prostate cancer into the RESPOND study. Investigators in the study will examine possible associations between aggressive disease and exposures to neighborhood/environmental stressors such as discrimination, early-life adversity and segregation. They will also study DNA and tumor samples to identify gene variants associated with aggressive prostate cancer.
Once researchers have identified genetic changes associated with aggressive prostate cancer, they will investigate how the social environment interacts with those genetic changes.
“Previous research on prostate cancer disparities has investigated social and genetic factors separately, but we know these components interact with each other to contribute to disparities,” said Damali Martin, Ph.D., program director for the study in NCI’s Epidemiology and Genomics Research Program.
“The ability to integrate genetic and environmental factors, including individual, neighborhood, and societal factors, into one large study will enable us to have a better understanding of how all of these factors contribute to the aggressiveness of prostate cancer.”
RESPOND is supported by the National Cancer Institute (NCI) and the National Institute on Minority Health and Health Disparities (NIMHD), both parts of the National Institutes of Health, as well as by the Prostate Cancer Foundation (PCF). The NCI funding will be provided from the 21st Century Cures Cancer Moonshot Initiative.
For more information, vist nih.gov.
The Prostate Cancer Puzzle
A massive study aims to recruit 10,000 African-American men and find answers about health disparities tied to the deadly disease.
IT'S A MEDICAL MYSTERY with fatal consequences: African-American men with prostate cancer are more likely to get and twice as likely to die from the disease than their white counterparts, and no one knows exactly why.
Uncovering reasons behind these stark health disparities is the goal of an ambitious $26.5 million study commencing this month and backed by the National Institutes of Health. With a target of recruiting 10,000 African-American men to participate, researchers will examine whether poverty, the lingering effects of segregation and the stress of day-to-day racism are to blame, as well as look for genetic markers of risk for the disease.
"It's one of the largest and most comprehensive studies" ever conducted of prostate cancer in the African-American population, says Christopher Haiman, a preventive medicine professor at the University of Southern California's Keck School of Medicine and the study's lead researcher.
"The reason for the highest incidence of aggressive (prostate) cancer and higher degree of mortality" among black men "is a question that has gone unanswered," he says.
A broad range of factors – including the medical research community's lack of inclusion of African-American subjects, and the black community's persistent suspicion of race-specific medical studies – has resulted in a dearth of information about a potentially deadly disease that disproportionately affects black men.
Before now, "previous large-scale research efforts have focused primarily on white men," Haiman says. "This project is a step towards understanding what factors contribute to disparities so that we can work towards eliminating them."
Titled RESPOND, for Research on Prostate Cancer in Men of African Ancestry, the study aims to create a DNA database on the disease. Haiman, an epidemiologist who specializes in the genetic bases of cancer in minority populations, says researchers will be recruiting African-American men from cancer registries from seven states: California, Florida, Georgia, Louisiana, Michigan, New Jersey and Texas. Saliva samples will be collected from a majority of participants, and tumor samples from about 3,000.
But researchers also want information about the lives of men enrolled in the study, specifically regarding "exposures to neighborhood/environmental stressors such as discrimination, early life adversity, and segregation," according to an NIH statement. Men will be asked to complete an online survey allowing researchers to assess these stressors, according to a USC statement.
"We're going to be looking at geographic distribution of the social stressors, and social adversity factors that may lead to stress," Haiman says – information he anticipates will match historic patterns of racism, poverty and undereducation.
"We do have some hypotheses that have led us down this road," he says.
Operating on a five-year timetable, RESPOND is funded in part by the Obama administration's 21st Century Cures Cancer Moonshot initiative. The study is a joint effort among the National Cancer Institute and the National Institute on Minority Health and Health Disparities, both part of the NIH, as well as the Prostate Cancer Foundation and researchers from institutions including USC and Johns Hopkins University.
While doctors and scientists have questions about the causes of the disease, the outcomes have been clear for decades. According to the American Cancer Society, black Americans as a population have the highest death rate and shortest survival of any racial or ethnic group in the U.S. for most cancers.
"The causes of these inequalities are complex and reflect social and economic disparities more than biological differences," an ACS report on the issue states.
"Socioeconomic disparities reflect inequitable access to opportunities and resources," the report says. That includes in areas "such as work, wealth, income, education, housing, and overall standard of living, as well as barriers to high-quality cancer prevention, early detection, and treatment information and services."
And if prostate cancer has become a crisis for black men, Louisiana is among its epicenters.
Data from the National Cancer Institute and Louisiana Tumor Registry show the state had one of the highest rates of prostate cancer diagnoses in the nation from 2010 to 2014 and that the disease was the third-leading cause of cancer deaths in Louisiana men. Among African-American men in the state, the rate of invasive prostate cancer far exceeded that of white men, and – depending on age at diagnosis – was above the national average.
"It varies year by year, but we're towards the top. We're up there," says Dr. Scott Delacroix, director of urologic oncology for the Louisiana State University Health Sciences Center New Orleans.
The LSU center is responsible for the Louisiana Tumor Registry, which is among the seven state cancer registries researchers will draw upon for the study. Delacroix says LSU "gladly" joined the NIH's quest for answers to the mystery of prostate cancer and its deadly impact on African-American men.
The Bayou State is fertile ground for the survey because it's a key part of the South's "black belt" – a crescent of communities in former slave states where high percentages of African-Americans still live.
"Incidences of prostate cancer (here are) actually higher than the U.S. average," Delacroix says. "Our mortality is still unacceptably high. But when you compare the mortality rate of African-Americans in Louisiana versus the national average, our mortality rate is actually lower than the national average."
Besides creating a database that can help researchers identify the intersection between biological and environmental drivers of prostate cancer, Delacroix says the RESPOND project can address another problem: that of doctors ordering invasive treatments that African-American men may not need.
"Regardless of your race, many men are diagnosed with clinically insignificant" prostate cancer, Delacroix says. That can lead to treatments with serious consequences, ranging from temporarily side effects caused by medications to possibly life-altering conditions like erectile and urinary dysfunction.
At the same time, some health disparities and mortality among both African-Americans and whites can be linked to an absence of specialty care, Delacroix says, especially in underserved areas that lack accessible hospitals or clinics.
Still, addressing the issue requires research, says Haiman, the USC professor and RESPOND lead researcher.
"We have identified genetic variations that are only found in men with African ancestry, and other (variations) that are more common in men of African ancestry," Haiman says. "We need a much larger sample size to continue to analyze those risk variances and the degree of aggressiveness" of prostate cancer that develops.
"Previous studies have only been able to recruit a few hundred, or maybe a thousand" participants, he notes.
A study published in 2010 in the Journal of Health Care for the Poor and Underserved noted the lack of participation of African-Americans is rooted in several factors, including "study design, logistical problems, (and) low levels of health literacy."
Haiman says the NIH-backed study will enlist faith and community leaders to help recruit subjects. As word spreads about the study, he says, black men across the country will be encouraged to submit information online and participate in the research.
"It's definitely a challenge," he says. "This is a challenging population to be working with for many historical reasons. We're doing our best to build a trust with the African-American community, and we're including patient advocates and other community leaders. So far, I've actually been quite surprised by the willingness and eagerness of men to participate in this research."
"Only through participation can things get better," he says.
If You’re a Black Man, You’re Twice as Likely to Die from Prostate Cancer
Researchers are tackling why black men are more at risk than white counterparts.
Prostate cancer is, aside from skin cancer, the most common cancer diagnosed in American men. Hundreds of thousands of men are diagnosed with the disease every year, and statistically about 1 out of every 41 men will eventually die of prostate cancer.
Perhaps the most dramatic statistic when it comes to prostate cancer in the United States is the way that prevalence varies among different racial groups. Among four groups —white, American Indian, Asian or Pacific Islander, and Hispanic — the rate of new diagnoses is anywhere between 49.6 and 90.2 per 100,000 men.
For African-American men, however, the rates are much higher, with 158.3 new diagnoses per 100,000 men. In fact, African-American men are twice as likely to die from the disease as white men.
This disparity is nothing new — but even though it’s long been noted in medical literature, there are no concrete reasons as to why such a gulf exists.
A new initiative, funded through the Cancer Moonshot initiative spearheaded by former Vice President Joe Biden, seeks to understand, and hopefully fix, this disparity.
Research for the long run
The $26.5 million study is called “Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers, and Social Stress,” or RESPOND for short. It’s a joint effort of two National Institutes of Health entities (the National Cancer Institute and the National Institute on Minority Health and Health Disparities) and the Prostate Cancer Foundation.
The findings will surely be illuminating, but it’ll take some time to get there.
“This is a five-year grant, so at the end of five years, we expect to have a better understanding of the social and genetic variants that contribute to aggressive prostate cancer, and how those factors interact with each other,” explained Damali N. Martin, PhD, MPH, program director, genomic epidemiology branch of the National Cancer Institute (NCI), told Healthline.
“We hope that increased knowledge of the factors that cause prostate cancer will provide us with new ways to identify African-American men, and men in general, who are at risk of developing aggressive prostate cancer, and hopefully also help us in terms of the development of positive screening and prevention strategies.”
Researchers plan to enroll 10,000 African-American men with prostate cancer into the study, where various social, environmental, and genetic factors will be examined.
What are the possible causes?
While health professionals have long known that African-American men are more susceptible to prostate cancer, there’s a multitude of potential theories.
“Although many people have theorized as to what factors may contribute to it, we still have almost a blank page as to understanding why there is a disparity,” Dr. Steven Clinton, director of genitourinary oncology at The Ohio State University Comprehensive Cancer Center, told Healthline.
“The table is full of hypotheses, ideas, and concepts about what factors contribute. I don’t think there’s going to be one, I think there will be multiple factors, and now’s the time to invest in understanding it so we can eliminate this very significant disparity in cancer risk and dying from prostate cancer.”
“What we also know, in terms of genetics, is that there may be some genetic variants that are associated with aggressive prostate cancer, that are unique to African-American men, but not seen in other populations.”
When it comes to best-practice advice, it’s best, as always, to speak with your doctor. Prostate cancer typically develops in men after they turn 40, meaning it’s important for middle-aged men to be vigilant.
“I personally believe that screening is important for men, and it’s particularly important for African-American men. Even more important, if someone has a first-degree relative — meaning a father or a brother — with prostate cancer, they should be screened and educated appropriately,” said Clinton.
Martin says that understanding cancer disparities is key to developing the strategies and treatments of the future.
“As we move toward personalized medicine and implementation of 21st-century cures, it’s important to ensure that every person has the opportunity to benefit from research advances,” she explained. “This study will help to advance an important research priority for NCI, which is understanding factors of cancer disparities, and in particular, prostate cancer disparities.”
“We hope that increased knowledge of the factors that cause prostate cancer will provide us with new ways to identify African-American men, and men in general, who are at risk of developing aggressive prostate cancer — and hopefully also help us in terms of the development of positive screening and prevention strategies.”
National African American Prostate Cancer Study includes Baylor College of Medicine
Baylor College of Medicine is among a national network of health care institutions and collaboratives recruiting for what is described as the largest coordinated research study of aggressive prostate cancer in African American men.
An estimated 30,000 African American men were diagnosed with prostate cancer in 2016, according to the American Cancer Society’s most recent figures, and the disease is believed to have killed more than 4,400 black men that year. Black men are twice as likely to die from prostate cancer than white men and have the highest death rate from the disease among all racial or ethnic groups in the United States, findings show.
Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers, and Social Stress—also known as RESPOND—is a $26.5-million, multi-institutional study funded by the National Cancer Institute, the National Institute on Minority Health and Health Disparities and the Prostate Cancer Foundation.
RESPOND will examine the impact of social stressors such as discrimination along with socioeconomic status, education, home life, residence location and early life events as well as genetic and biological factors in the development and progression of prostate cancer in African American men. The study also will explore why black men are at higher risk for developing more aggressive forms of the disease and why their mortality rate is higher.
“While looking at cases, Texas stood out,” she said. “Some 1,700 African American men are diagnosed in Texas annually.”Leading the study for Baylor is Melissa Bondy, Ph.D., professor of medicine – epidemiology and population sciences and associate director of cancer prevention and population sciences in the Dan L Duncan Comprehensive Cancer Center.
The study aims to recruit 10,000 African American men nationwide over the next five years. Each participant will be asked to provide a saliva sample and allow researchers to access his prostate cancer biopsy tissue. The samples will be analyzed to identify genetic markers of prostate cancer and unique tumor characteristics.
Recruiting this population may be a challenge, said Bondy, who has previously sought participants for breast cancer research. This will be her first time recruiting for prostate cancer.
She noted that men, in general, don’t like to participate in research, but said the prostate cancer researchers are getting creative in their approach by looking at recruitment through barbershops.
“We may have to rethink how to do this,” she said. “This is a hard group to reach. They are not used to participating in research and tend to be older men. They are also more curious about what we will do with the information.”
Bondy hopes to enroll about 3,000 study participants from Texas with a process that will kick off with focus groups this summer. Recruitment begins in January.
The Keck School of Medicine at the University of Southern California will lead the study. Other participating institutions include Rutgers Cancer Institute of New Jersey with the New Jersey Department of Health, Public Health Institute with the Cancer Registry of Greater California, Emory University, Dana-Farber Cancer Institute with Harvard University, Johns Hopkins University, Louisiana State University Health New Orleans, Moffitt Cancer Center, Barbara Ann Karmanos Cancer Institute with Wayne State University and the University of California, San Francisco.
African American men hardest hit by prostate cancer
September is dedicated to raising awareness about the disease
NASHVILLE – One in nine American men will be diagnosed with prostate cancer, which is the second leading cause of cancer death and the most commonly diagnosed.
In 2018, nearly 165,000 new cases of prostate cancer are expected in the United States with nearly 3,000 of those in Tennessee. That is forecasted to result in nearly 30,000 lives lost to prostate cancer across the country and 550 across the state.
Among those statistics, one in six African American men will develop the disease in his lifetime, which is almost two times the rate of white males. African American men are also 2.3 times as likely to die from the disease.
“Finding prostate cancer at an early stage gives patients the best hope for effective treatment and to live cancer free,” Mike Leventhal, executive director of Tennessee Men’s Health Network. “That is why it is crucial for Tennesseans to know about and understand the disease, especially African American men who are being affected in larger numbers.”
“We also know that more research needs to be done to find more effective and advanced treatments for these men,” Leventhal continued.
If the disease progresses to advanced stage, also known as metastatic castration-resistant prostate cancer (CRPC), the prognosis becomes poor with a median survival rate of around 3 years.
Patient outcomes are positively impacted by improved awareness of the disease, an understanding of increased risks for developing it, and access to recent medical advances that can extend the time a patient lives without his cancer spreading.
Tennesseans are encouraged to talk to their physicians regarding their potential risks to developing prostate cancer as well as when screening and related tests for early detection are needed.
For individuals diagnosed with prostate cancer, shared decision making between the patient, his family, other caregivers, and his physician is important to support the right care, and patients should talk to their doctor to learn more about the disease, treatment options and to find support groups and services in their communities or online.
Tennessee Men’s Health Network is an affiliate of the Men’s Health Network headquartered in Washington, D.C. TMHN is a private nonprofit educational organization comprised of physicians, researchers, public and private health professionals, and individuals. TMHN is committed to improving the health and well-being of men and boys in Tennessee through educational campaigns, data collection, and collaborative efforts with health care providers to promote programs and funding on men’s health needs. For more information visit www.menshealthnetwork.org or contact 865.406.0129.
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