Abstract IA10: Risk and appropriate screening of African-Americans for prostate cancer
Authors: Powell Isaac J. 
Published: February 2019

Abstract
In 2017 the US Preventive Services Task Force (USPSTF) reevaluated recommendation included support for screening men aged 55 to 69 years, but did not include African American men (AAM) because of lack of evidence. Their recommendation was based on evidence from a European study. However, in 2015 we reported (Powell et al., CEBP) that prostate cancer (PCa) survival among AAM was significantly worse than European American men (EAM) before PSA screening, but after the advent of PSA testing, 1995 to 2005, PCa survival was found to be similar among AAM compared to EAM. Another study reported that screening should begin for AAM at least nine years before EAM testing. Therefore AAM should begin PSA screening at approximately age 45 years. These studies were not included in the most recent USPSTF analysis. Even though survival is currently similar among AAM and EAM, the risk of PCa diagnosis has been reported to be 60% greater among AAM than other ethnicities and the mortality rate reported as 2 to 3 times greater among AAM than other ethnicities by SEER (Surveillance Epidemiology and End Results) analysis from 1973 to 2014. Our team at Wayne State University/Karmanos Cancer Institute has reported that PCa grows faster among AAM than among EAM based on our autopsy study, clinical data, and SEER data (CEBP, 2010). PCa starts at the same time among these groups but reaches distant disease at a 3 times greater proportion among AAM and at a younger age than EAM. This may account for much of the disproportionate mortality rate, but there are other factors that may contribute as well to such racial disparity of treatment. There is growing genetic and biologic evidence to support the disproportionate growth rate findings. Wallace et al. (Cancer Res 2008) reported that genes that facilitate PCa cell movement from the prostate gland to bone and are expressed in metastatic PCa tissue were greater among AAM than EAM. In 2013 we reported that genes associated with PCa are differentially expressed in AAM and EAM (Powell et al., CEBP). Functional driver genes more expressed among AAM were mostly proinflammatory cytokines, and those more expressed among EAM were lipid metabolism genes and ERG. It has been reported that proinflammatory genes are associated with aggressive PCa and activate transcription factors that activate the androgen receptor and cause PCa proliferation. They have other functions such as angiogenesis and being indirectly responsible for downregulation of cell adhesion molecules. They also play a role in several biologic pathways contributing to advanced disease. Further studies are needed such as validation of our data, comparison to other genetic panels, and identifying methods to personalize or individualize these genetic findings.
Citation Format: Isaac J. Powell. Risk and appropriate screening of African-Americans for prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr IA10.