Prostate Cancer in Black

Males as Compared to the

General Population in
Massachusetts
Richard Macdonald, Michael Pires, and Ernesto Barbosa
June 2017

1
Health Disparities

Racial Identity of Massachusetts Citizens 19

 Health disparities occur

when the rates of disease
Other
occurrence vary between a Asian
7%

socioeconomic, geographic, Black

5%

or racial group compared to 6%

the general population Hispanic or

Latino
 Blacks, who only compose 6% 9%

of the Massachusetts
population, are subject to
White
health disparities such as 73%

prostate cancer

2
Definition and Prevalence of Prostate
Cancer
 Prostate cancer is the second most
diagnosed form of cancer in men,
and is the sixth most frequent cause
of death among all cancers 4
 Prostate produces seminal fluid, which
is responsible for the nourishment and
transport of sperm
 The prostate also controls urinary
continence, the ability to control Location of the prostate in a man’s body, cross section
of a healthy prostate, and cross section of a prostate
urination with a cancerous mass 6

3
Diagnostic Tests for Prostate Cancer

 Prostate specific antigen (PSA) is a

protein produced by prostate cells, and
can occur in high amounts when
prostate cancer is present
 PSA levels are often detected via blood
tests
 Levels above 4 ng/mL often lead to biopsy
 Digital rectal examination (pictured)
 Biopsy
Source 12

 Tissue sample from prostate is taken and

checked for cancerous mass
4
Prostate Cancer Incidence, Hospitalization,
and Mortality Rates in MA Between Races

 Incidence rates are 68% Mortality, Hospitalization, and Incidence of

Porstate Cancer by Race
higher in blacks as in whites, 300
who compose the majority of

Age-Adjusted Rate per 100,000 MA Residents

250 264
the population 14
200
 34% higher rate of 150
hospitalization due to
157.5

100
prostate cancer in blacks as 85.1

in whites 14 50 63.5
47.4
21.2
0
 124% higher mortality rate Incidence Hospitalizations Mortality

among blacks as whites 14 White Black

5
Genetic Risk Factors for Developing
Prostate Cancer
 Risk for developing prostate
cancer is affected by
polymorphisms in specific
genes
 One controls the absorption of
calcium in cells of the small
intestine 18
 Prostate cells respond to
increased calcium intake by
multiplying at a faster rate
Model of transcription factors attaching to a binding site
prior to protein synthesis 20.

6
Genetic Risk Factors for Developing
Prostate Cancer, Continued
 Blacks are more likely to have the more
active allele, leading to more receptor
production 18
 Since increased calcium absorption leads to
a higher risk of prostate cancer, blacks are
more likely to suffer from the disease
 High levels of calcium intake increased
men’s risk for advanced prostate cancer
 People with a family history of prostate
cancer are more likely to develop the
disease 18
Source 5

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Risk Factors: Obesity

 Obesity increases calcium absorption

Overweight, Obesity, and Hypertension Rates
 Leads to increased likelihood of in MA by Race
developing prostate cancer 4, 18 80

Detection biases among obese men: 4 70

Percent of MA Population

67.1
60
 Naturally lower PSA levels prevent 57.9
50
further screenings
40
 Physicians have a more difficult time 30
30.6 30.2
performing complete digital rectal 20 26.6
21.7
exams 10
 Obese men have larger prostates, 0
increasing the surface area that Overweight Obesity Hypertension
prostate cancer could occur over White Black

8
Risk Factors: Obesity, Continued

 In addition to higher rates of incidence,

obese men are more likely to experience
fatal cases of prostate cancer 4
 Larger amounts of fat tissue cause the prostate
and prostate cancer to move more in obese
men 4
 Less radiation hits the cancerous mass during
radiation therapy, leaving some behind
 As a result, obese patients who undergo
radiation therapy are more likely to experience Zakariyya, an obese man from The
Immortal Life of Henrietta Lacks 8
biochemical recurrence 4
9
Risk Factors: Insurance and Definitive
Treatment
 Compared with white men, black men have a
significantly lower probability of receiving
definitive treatment 11
 Black men with high risk prostate cancer are less than
half as likely to receive definitive treatment in
comparison to white men
 Largelyas a result, black men who develop prostate
cancer are more likely to die from the disease
 Insuredblack men were less likely to receive definitive
treatment than uninsured white men
10
Risk Factors: Insurance and Definitive
Treatment, Continued

 Blacks are more likely to experience racially

discordant physician visits 13
 These visits are shorter in length and less patient-centered
 The patient plays less of a role in decision making
 White physicians spent less time planning treatment,
educating, assessing health knowledge, engaging in
conversation, and answering questions of black patients
 There are 40 times less black urologists in the field
than whites 23
 As a result, even people with a heightened perceived
risk are unlikely to reach out to resources 17
11
Risk Factors: Perceived Risk of Prostate
Cancer

 Blacks are unlikely to recognize that they are at increased risk

for prostate cancer 17
 Their lowered perceived rate was directly associated with their
socioeconomic status, income, etc.
 Older men do not see themselves as having a higher risk than
young men 17
 The lack of education of prostate cancer in blacks may be due to
the uncertainty of benefits of diagnostic measures 17
 Community based efforts are important to educate and inform
blacks about prostate cancer issues and prevalence

12
Present Efforts to Educate Prostate
Cancer Survivors
 Prostate Health Education Network (PHEN) 3

 Helps spread knowledge about prostate cancer

to combat lack of awareness about prostate
cancer
 Holds and broadcasts summits to find solutions
toward ending racial disparities in prostate
cancer
 Broadcasts public service announcements over
the radio
 Creates a survivor network for people who have
survived prostate cancer
 General monthly support meetings
 Partnered with UMass Medical School and UMass
Memorial Health Care Sources 15, 21, 22 13
Recommendations to Reduce Prostate
Cancer Risk and Disparities

 People at higher risk for prostate cancer, especially blacks, should

limit their calcium intake 18
 Increased exercise helps protect against aggressive forms of prostate
cancer, which are more prevalent in blacks 3, 4
 If prostate cancer in an obese man is not far along or of low risk,
devoting a few months to weight loss prior to treatment may result in
a better outcome 4
 Obese men should be educated about their increased risk of
recurrence after having a procedure to remove the cancer 4

14
Summary

 Black men have higher incidence, hospitalization, and mortality rates

than the general population
 Blacks are more likely to absorb more calcium resulting from genetics,
putting them at higher risk of prostate cancer
 Since a higher percentage of black men are obese, risk factors
resulting from obesity affect blacks disproportionately
 Black men are less likely to receive definitive treatment for prostate
cancer, even if they have insurance
 Blacks are unlikely to recognize they are at a higher risk of prostate
cancer
 Multiple steps can be taken to help close the disparities black men
experience in diagnosis and treatment of prostate cancer
15
“Knowing is not enough; we
must apply. Willing is not
enough; we must do.”

-Johann Wolfgang von Goethe

16
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9. Helfand, B., Kearns, J., Conran, C., & Xu, J. (2016). Clinical validity and utility of genetic risk scores in prostate cancer. Asian Journal
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10. Krane, Jenny (2016). Black Patient with White Doctor. Retrieved from http://cdn.viralitytoday.com/posts/6l4HJ/JIuVx7kC.jpg.

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doi:10.1111/j.1540-4560.2012.01751.x
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