Why do men of African descent die of prostate cancer more frequently than other men and suffer the greatest burden of advanced prostate disease globally?
A large-scale retrospective analysis by researchers at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine suggests that differences in treatment, rather than genetics, likely explain the disparities in advanced prostate cancer among men of African and European ancestry.
The study of nearly 13,000 men with advanced prostate cancer, published May 24 in The Lancet Digital Health, is one of the most comprehensive studies to date of prostate cancer disparities among men of these ethnicities.
I believe this is the largest and most representative genomic study of advanced prostate cancer in men of African and European ancestry, said Dr. Brandon Mahal, assistant professor of radiation oncology at Sylvester and senior author of the study.
The data clearly show no notable differences in gene mutations between ancestors we would like to target for treatment, suggesting that these mutations are likely not driving disparities in advanced prostate cancer, said Dr. Mahal.
Mahal and coauthors found that men of African descent, despite being at higher risk of developing aggressive prostate disease, were less likely to obtain a complete genetic profile of their tumors at the start of treatment. That means they don’t benefit as often as their European counterparts from sophisticated tests that can guide gene-targeted therapy and lead to better patient outcomes. Instead, they may undergo other, sometimes less effective, treatments as their cancer progresses.
Men of African descent were also less likely than men of European descent to undergo clinical trials for prostate cancer, which typically involve newer, more effective treatments for the aggressive disease, Mahal noted.
We’ve known for a couple of decades that prostate cancer disparities are some of the biggest disparities we see across all types of cancer. This research can help focus our efforts on what is needed to address these disparities, she said, adding that future studies should not ignore the examination of genomics.
While this study looked at advanced prostate cancer and diminished the focus on genomics as a reason for the disparities, there is still a case for studying the role of genomics in men’s risk of developing prostate cancer, Mahal concluded.
Sylvester worked on this study in collaboration with researchers at Foundation Medicine, the University of Michigan and Harvard Medical School.
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