Prostate cancer study
Prostate cancer study

Risk factors for prostate cancer include increasing age, the longer you live on this earth as black man, the higher your risk of prostate cancer if you do nothing to prevent it, a family history of the disease in a first-degree relative, body weight , and ethnicity- black man.

Prostate cancer study
Prostate cancer study

According to Lloyd et al 2015, Prostate cancer incidence rate data in England show that Black (Black African, Black Caribbean, and Other Black) men are considerably more likely, and Asian (Indian, Pakistani, Bangladeshi, and Other Asian) men significantly less likely, to be diagnosed with the disease compared to White men.

The Prostate Cancer in Ethnic Subgroups (PROCESS) study, and others, calculated Black men are 2 to 3 times more likely to be diagnosed with prostate cancer compared to White men of the same age for instance in the UK. In addition, the PROCESS study showed Black men may be diagnosed 5 years younger than White men, despite equal access to diagnostic services between ethnic groups.

Another systematic review and meta-analysis showed that Black men diagnosed with prostate cancer have a poorer prognosis compared to White men. Conversely, all of the studies included in the analysis were based in the United States, where the poorer prognosis in Black men is thought to be due to their less privileged socioeconomic position, and therefore reduced access to health services which require the patient to pay, and not necessarily due to them being more likely to be diagnosed with aggressive prostate cancer.

Scrutiny of the UK PROCESS study found no evidence of a difference in disease characteristics (stage and Gleason score) at the time of prostate cancer diagnosis or of under-investigation or under-treatment in Black men compared with White men of the same age in the UK .

Black men are more likely to undergo radical treatment compared to White men, although this can be largely explained by their younger age at diagnosis. Black men for instance in the UK are diagnosed at a younger age. Black men diagnosed with prostate cancer I have had encountered with are in their forties and fifties diagnosed.

One man told me about his ordeal in the prostate cancer journey when he read about my work on modernghana platform. He came to Ghana to see and he told me how during his visit at the hospital the white men were just looking at him as a young man diagnosed with the disease. He told me that this exit in the black communities with lot of his colleagues diagnosed with the disease in the UK. One thing he also told was that during the diagnosis the doctor told him that he lacks vitamin D and that was his problem and was introduced to vitamin D supplement.

Prostate cancer endurance data in the UK show no significant difference in survival rates between Black and White men. According to research, the high proportion of cases with unknown ethnicity makes interpretation of these results extremely difficult. Increasing survival and an aging population have led to more men dying from prostate cancer at an older age. Prostate cancer mortality rates have been calculated as being 30 % higher in Black than in White men in England, although this was not completely adjusted for population age, so it is difficult to draw conclusions on differences in mortality rates.

The reasons for the increased risk of prostate cancer in Black men are not yet fully understood, partly due to the exclusion or under-representation of Black men in large-scale genome wide association studies, and clinical trials such as the European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial . Prostate cancer in the black community presents with lot of disparities including screening and treatment.

According to the prostate cancer UK, 1 in 4 black men will get prostate cancer in their lifetime ‘Lifetime risk’ is an estimation of the risk that a newborn child has of a certain event occurring at some point during their life. Lifetime risk calculations are based on current incidence and mortality rates and are therefore calculated under the assumption that the current rates, within each age group, will remain constant during the life of the newborn child. Lifetime risk is usually expressed as a percentage, e.g., 20 %, or using odds, e.g., 1 in 5. Lifetime risk odds are rounded up to avoid overestimating risk, e.g., 1 in 4.1 would be rounded up to 1 in 5.

In Ghana for example, the men’s health foundation say that 1 in 5 Ghanaian men will get prostate cancer in their lifetime. The challenged also with lifetime risk calculation has to be a lack of data on ethnicity created difficulty in calculating the lifetime risk of diagnosis and dying by major ethnic group. Prostate cancer incidence is recorded by cancer registries and, depending on the data source, information on ethnicity is variable. Ghana has a big problem with cancer registries making it difficult to access information.

One in four Black men will be diagnosed with prostate cancer in their lifetime. One in twelve will die from it. Comparably, more Black men are dying from prostate cancer than white men. The situation is even worse in Ghana as 1,000 men diagnosed and 800 die of the disease. In a nut shell when 10 men get prostate cancer, 8 will definitely die of the disease. In fact, Black men are twice as likely to be diagnosed with, and die from, prostate cancer. The disease is also very aggressive in black men than white men partly because of biochemical difference-lack of vitamin D

It’s vital we understand the reasons behind why this is the case, which is why the Prostate Cancer UK for instance, is funding two key pieces of research in this area. Dr Christine Galustian from King’s College London is investigating whether the absence of a protein called DARC (which helps slow the spread of cancer) in 60% of Black men is linked to a higher risk of developing aggressive prostate cancer.

Dr Myra McClure from Imperial College is taking a different approach, and determining whether viral infection might have a role in prostate cancer development in Black men.

While the difference in the risk of being diagnosed with prostate cancer between Black and white men is shocking, it is compounded by the fact that so few Black men are aware that they’re at increased risk. For instance, only 8% of Black men in the UK know that they’re at higher than average risk of prostate cancer. Worse, 23% think that their risk is lower than average.

This clearly needs to change. The UK piloted a project call ‘Be Clear on Cancer – Prostate Cancer’ awareness-raising pilot that headlined the one in four risk stat for Black men in six London Boroughs. It encouraged Black men to know their risk of prostate cancer and, if they were 45 and over, to talk to their GP about whether a PSA test was right for them. This pilot is being evaluated at the moment.

In Ghana, the men’s health foundation Ghana kick off their Ghana Prostate Cancer Awareness program and appealed to the president to recognized the father’s day as national prostate cancer day in Ghana to help raise awareness on the disease.

The Prostate cancer UK is one organization doing a great work in the black communities in the UK and it’s about time charities in Africa need to speed up the awareness. Physicians also in the black communities need to wake up!

The finding that Black men are at double the lifetime risk of being diagnosed with prostate cancer in England, compared to White men, provides Black men with important and useful information. The first step towards a diagnosis of prostate cancer is often a PSA blood test and, due to the high likelihood of false positive or false negative results, information about prostate cancer risk is an important factor for men when deciding whether or not to have a PSA test. To date, relative risk (to that of White men) has been used to communicate to Black men their increased risk of being diagnosed with prostate cancer.

More significantly, we must remember that every individual’s risk is different and will vary based on a combination of different factors in addition to ethnicity, such as age, family history of prostate cancer, and body weight.

Although there is not yet evidence that the benefits of screening an entire population of men for prostate cancer outweigh the risks but as the disease is striking more black men, we need to understand whether there would be an improvement in the benefit–risk ratio for screening targeted populations at higher than average risk of developing and dying from prostate cancer.

It is also important to remember that lifetime risk calculations are based on current incidence and mortality rates. Prostate cancer incidence rates have been rising since around the year 2000; if this trend continues, then younger generations may be at a higher lifetime risk of being diagnosed with prostate cancer than the current estimate. According to the GNA, Ghana has exceeded the global prostate cancer limit and this publication was in 2010-2012

We need more future research to address what lies behind the variations in prostate cancer risk based on ethnicity. The issue of skin color must be research extensively as we know vitamin D has a direct role to play in prostate cancer incidence and aggressiveness of the disease and if there is the need for vitamin D should be used as part of the prostate cancer screening tool apart from the PSA, digital rectal exams and ultrasound.

Current research into genetic biomarkers may begin to account for some of the difference in risk. Further data collection is required on PSA testing rates in primary care, broken down by ethnic group, to determine whether Black men are more likely to be diagnosed with aggressive disease.
There should be a better collection of ethnicity data in order to better understand differences based on ethnicity and to ultimately ensure all men receive the best level of tailored prostate cancer information, treatment, and care. Ghana and physicians in the black communities must rise up if we want to fight against the disease and reduce the disparity in prostate cancer and death rate in black men diagnosed with the disease.

Dr. Raphael Nyarkotey Obu is a registered Naturopathic doctor who specializes in prostate cancer and a PhD candidate in prostate cancer and alternative medicines –IBAM Academy, Kolkata, India. My research focuses on men of West African descent and prostate cancer and the dangme people. He can be reached on 0500106570 for all contributions. E-mail:[email protected] He is the director of Men’s Health Foundation Ghana; De Men’s Clinic & Prostate Research Lab-Dodowa,Akoo House.

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