Is prostate cancer different in black men? Answers from 3 natural history models

• Published in: Cancer 2017-06, Vol.123 (12), p.2312-2319
• Main Authors: Tsodikov, Alex, Gulati, Roman, de Carvalho, Tiago M., Heijnsdijk, Eveline A. M., Hunter‐Merrill, Rachel A., Mariotto, Angela B., de Koning, Harry J., Etzioni, Ruth
• Format: Article
• Language: English
• Subjects: African Americans - statistics & numerical data; Age; Cancer; cancer epidemiology; Computer Simulation; Diagnosis; Disease Progression; Early Detection of Cancer; Epidemiology; Health risk assessment; Health risks; Humans; Incidence; Kallikreins - blood; Male; mass screening; Men; Metastases; Metastasis; Models, Statistical; Natural history; Oncology; Policies; Population; Prevalence; Prostate cancer; Prostate-specific antigen; Prostate-Specific Antigen - blood; prostatic neoplasms; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - pathology; racial disparities; Risk; Screening; SEER Program; statistical methods and models; Studies; United States
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.30687

BACKGROUND Black men in the United States have substantially higher prostate cancer incidence rates than the general population. The extent to which this incidence disparity is because prostate cancer is more prevalent, more aggressive, and/or more frequently diagnosed in black men is unknown. METHODS The authors estimated 3 independently developed models of prostate cancer natural history in black men and in the general population using an updated reconstruction of prostate‐specific antigen screening, based on the National Health Interview Survey in 2005 and on prostate cancer incidence data from the Surveillance, Epidemiology, and End Results program during 1975 through 2000. By using the estimated models, the natural history of prostate cancer was compared between black men and the general population. RESULTS The models projected that from 30% to 43% (range across models) of black men develop preclinical prostate cancer by age 85 years, a risk that is (relatively) 28% to 56% higher than that in the general population. Among men who had preclinical disease onset, black men had a similar risk of diagnosis (range, 35%‐49%) compared with the general population (32%‐44%), but their risk of progression to metastatic disease by the time of diagnosis was from 44% to 75% higher than that in the general population. CONCLUSIONS Prostate cancer incidence patterns implicate higher incidence of preclinical disease and higher risk of metastatic progression among black men. The findings suggest screening black men earlier than white men and support further research into the benefit‐harm tradeoffs of more aggressive screening policies for black men. Cancer 2017;123:2312–2319. © 2017 American Cancer Society. Three models were used to study differences in prostate cancer natural history between black men and the general US population. The results demonstrate that black men have higher prevalence of preclinical disease at all ages and higher risk of metastasis, supporting further study into different screening policies for black men. See also pages 2203‐5.