What men need to know about factors that impact risk of prostate cancer

While anyone may be diagnosed with cancer, everyone has varying levels of risk based on genetics, environment, and lifestyle.

Certain larger populations may also be at increased risk compared to other groups. For instance, your risk of cancer may vary according to your race, ethnicity, socioeconomic status, geographic location or gender. In the case of prostate cancer, disparities exist in access to care, tumor biology and response to treatment.

The biological makeup of a tumor, as well as how you respond to treatment, may relate to your ethnicity, according to Dr. Farshid Sadeghi, medical director of the Genitourinary Center and urologic oncologist at Cancer Treatment Centers of America near Phoenix. African American men, for instance, are more than twice as likely to die of prostate cancer than European American men and five times more likely to die of the disease than Asian Americans.

"There are disparities in both the incidence and outcome for prostate cancer in African American men. This means that they get prostate cancer more often and when they do they are more likely to die from the disease," says Dr. Sean Cavanaugh, national director of the CTCA Genitourinary Cancer Institute.
African American men are about 1.6 and 2.6 times more likely to develop prostate cancer than whites and Asian Americans, respectively.

Why are African American men at increased risk of prostate cancer?
Both genetics and environmental factors play a role, Dr. Sadeghi states, and lack of access to healthcare can negatively impact patients in that they may be diagnosed later or not have access to all the available treatment options. Research published in Cold Spring Harbor Perspectives in Medicine suggests that inequities in health care access strongly influence prostate cancer disparities, which means, if you're an African American man, making sure you visit your physician regularly for check-ups and receive the recommended cancer screenings is of utmost importance. But there's likely more to the story than this.

In fact, according to Dr. Sadeghi, "In African American men, when we control for socio-economic factors -- such as access to health care--, the higher incidence of disease, the more aggressive nature of prostate cancer and the higher mortality rates from prostate cancer persist." This suggests that access to health care alone does not explain prostate cancer health disparities.

There can even be downsides to increased access to health care, particularly as it relates to prostate cancer, which is sometimes over-treated. "It should be noted that increased access to health care can also lead to over treatment of low-risk prostate cancer, which can, in many cases, pose a greater risk to the patient than the disease itself," Dr. Cavanaugh says. It's important to discuss the pros and cons of active treatment and active surveillance with your doctor in the event prostate cancer is detected - and knowing whether you're at a heightened risk may ultimately help you in your decision.

Biological differences are also likely involved in prostate cancer disparities - an area of research that continues to be explored. In a recent study, researchers analyzed prostate cancer samples and found interleukin-6 (IL6), a signaling molecule, is overexpressed in tissues adjacent to tumors in African American men compared to European American men. IL6 is known to make p53, a tumor suppressor protein, inactive and may fuel aggressive prostate cancer stem cells that lead to metastasis and resistance to cancer treatment.

"In my mind, there is no question that the disease acts differently on a biological level in an African American man relative to, say, a Korean American man," Dr. Cavanaugh says. "In fairness, there is disagreement and healthy debate among experts on this issue." Further, this isn't only an issue affecting African American men; disease rates often vary among different ethnic groups, and African Americans tend to have the highest death rate for many types of cancer, although this disparity has gotten somewhat smaller in recent years, according to Dr. Cavanaugh.
Prostate cancer rates also vary worldwide and knowing your heritage may be helpful information. "There are tremendous variations in prostate cancer incidence across the world," he says. "For example, the incidence of prostate cancer is twice as high in Helsinki, Finland relative to Tallinn, Estonia, which is only 50 miles away. In general, rates are much lower in Asia and higher in parts of Europe, North America and Africa."
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Part 1 of the Prostate Pep Talk chat originally held on Aug. 29, 2016.

Spreading the word about prostate cancer disparities
"It may not be possible to eliminate disparities that are genetic or biologic in nature," Dr. Cavanaugh notes. "We need to accept that there may be a biologic difference in the way this disease affects African American men and therefore resources must be dedicated to studying better screening and treatment techniques in that patient population."

This is why it's so important to raise awareness about the existence of prostate cancer disparities. Many men are unaware that they may be at an increased risk of prostate cancer. If they had this knowledge, they would be able to proactively seek increased screening or earlier diagnosis and treatment.

For instance, when it comes to the prostate-specific antigen (PSA) test, which screens for prostate cancer, there are different screening guidelines depending on your race/ethnicity. "Although public health policy references the increased risk for African American men, the message is not getting to the community and very few of my patients are aware that African American men have different PSA screening guidelines," according to Dr. Cavanaugh.

Raising awareness will also help to instill the importance of maintaining a regular relationship with your health care provider, so you don't miss out on important screenings, especially if you're at increased risk. "As physicians, we must realize that education is the key. We have to promote education at every level, and we have to build a culture where people make connections to the health care community early in their life and use that access with confidence," Dr. Sadeghi says.
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Part 2 of the Prostate Pep Talk chat originally held on Aug. 29, 2016.

Who should seek earlier screening
Be sure to talk with your physician about whether prostate cancer (or other cancer) disparities affect you and what that means for your health care going forward. If you have a friend or loved one who is at increased risk, be sure to share this information so they can also make informed health care decisions.

While guidelines suggest that men at average risk of prostate cancer begin screening for prostate cancer at age 50, those at high risk, which includes African American men, should begin screening at age 45, according to the American Cancer Society. Because prostate cancer in African Americans may be more aggressive and faster growing than in men of other races, earlier screening may help detect cancer before it has a chance to spread.

Most of the time, annual screening is recommended, but depending on your PSA levels, some physicians may recommend twice yearly follow-up screening for African American men. Your doctor can help you decide what level of screening is right for you. Remember, too, however, that cancer disparities are not the last word in dictating your overall risk of the disease, and there are many choices you can make, lifestyle-based and otherwise, that can influence your health outcomes.

Even if you're at higher risk of prostate cancer due to a factor you can't control, it doesn't mean you're guaranteed to be diagnosed with the disease (or a more aggressive form of it). As Dr. Sadeghi notes, "While we are aware of these disparities, the earlier we diagnose prostate cancer, the better the patient's chance of beating the cancer. We treat patients as individuals and try to tailor our evaluation and treatment to balance the probability of full recovery and their quality of life."

The information provided here is for educational purposes only. In no way should it be considered as offering medical advice. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.
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