NEW HOPE FOR AFRICAN AMERICANS
WITH PROSTATE CANCER
African-American men are 76 percent more likely to be diagnosed with prostate cancer and more than twice as likely to die of this disease than men of other ethnicities.
These numbers are certainly alarming, but a number of new initiatives are addressing some of the reasons for this disparity. Of even more importance, however, is the discovery of specific molecular markers that are only present in African American men and a drug currently in development that targets these distinct anomalies.
Don’t Ask, Don’t Tell
Women are far more likely to get regular mammograms and/or regular gynecological examinations that can screen for various cancers that are specific to females than men. Results from a Harris Poll survey published in 2015, show that nearly 7 in 10 men (68 percent) sometimes ignore the symptoms of prostate cancer, instead of speaking up about changes in their body that are bothering them. They believe they have to be strong and handle things on their own, thereby, potentially risking their health.
The phenomenon of men not seeking medical attention for prostate symptoms is even more pronounced in African American men due to an inherent mistrust of the medical community. This skepticism is not entirely unfounded as recent studies indicate that older African American men are more likely to receive an inferior level of care when compared to white men. Harvard researchers have reported that African American men that were ultimately diagnosed with prostate cancer had to wait 7 days longer for care and the overall quality of care relevant to a radical prostatectomy (prostate removal) was rated to be decidedly less, but had a higher associated cost.
New Efforts to Address the Prevalence of Prostate Cancer in African Americans
There are a number of recent initiatives that have been undertaken to address the issues relevant to why African American men are not seeking and receiving a level of care that is commensurate with the prevalence and severity of prostate cancer among Black men. The first steps are simply raising awareness in the hopes that they will seek help if they have any symptoms or increase the frequency of screenings, especially if they have any family members that have been afflicted with the disease.
Baseball All Star Ken Griffey Sr. is the spokesperson for the “Men Who Speak Up” tour with his son, Hall of Famer Ken Griffey Jr.
With a shared talent and love for baseball, Ken Griffey Jr. and his Dad, Ken Griffey Sr., have always been close. They were even teammates at one legendary point. Despite their closeness, the father and son baseball greats learned that after Ken Sr.’s prostate cancer diagnosis in 2006, there were still some things they were uncomfortable sharing.
Ken Griffey Sr., a former Cincinnati Reds outfielder and three-time All-Star who won two World Series titles with the Reds, knew prostate cancer, the second most common cancer among men in the U.S., ran in his family. It took the lives of four of his uncles. Ken Sr.’s mother always talked to her sons about paying attention to the possibility of prostate cancer and they knew it was something they had to take seriously, he says.
But even growing up with the reality of prostate cancer, he still wasn’t prepared for the diagnosis that came as the result of a routine screening. “I didn’t know what to do with the information at first, let alone talk about it.”
Like many men, he initially lived with his diagnosis in silence.
For the man that had been so engaged about his prostate cancer screenings and prevention, Ken Sr. was surprised how difficult it was for him to talk about.
“After my prostate cancer was publicly announced, I went golfing with a group of friends and found out that several of them had prostate cancer. They hadn’t felt comfortable sharing the information until it had made headlines with me.”
Although great strides have been made in raising awareness for prostate cancer, as Ken Sr. points out, the conversations still rarely go beyond early stage disease and screenings, “leaving a gap in terms of what happens when prostate cancer advances.”
“Black men don’t talk about prostate cancer,” Ken Griffey Sr. told the St. Louis Prostate Cancer Coalition at a public event at the Chase Park Plaza Hotel.
“It was found early enough that I didn’t have to have radiation or chemotherapy,” he said. He has now been without prostate cancer for almost 12 years. He still gets his PSA checked each year.
Basketball Great Grant Hill and his Father, NFL Running Back Calvin Hill, Lead Prostate Cancer Awareness Drive
The Atlanta Hawks basketball team is making donations with every assist in February of 2019 to fight prostate cancer as part of the team’s recognition of Black History Month.
For each Hawks assist this month, the team is donating $250 to the Prostate Cancer Foundation. The drive is led by Grant Hill, the Vice Chair of the Hawks, and his father, former NFL running back Calvin Hill.
The Hawks say their goal is to bring awareness to the most common non-skin cancer in America.
Grant Hill says the drive “is a great opportunity to educate in a way that could potentially save lives.”
The Hawks have teamed with the Prostate Cancer Foundation for a campaign aimed at education and awareness of the disease that affects more than 4 million men in the United States.
Jonathan W. Simons, MD, PCF’s president and CEO, said in a statement released by the Hawks, “It is befitting that during Black History Month, we all work to change the outcomes of the men who are most severely impacted by this disease. Raising awareness of the risks, leading conversations that shift attitudes and making the facts about prostate cancer easily accessible, will literally save lives. The Hawks are changing history by altering the course of this disease and its impact on African-American men.”
Prostate cancer is the most common non-skin cancer in America and the fourth-most common tumor diagnosed worldwide. Despite its frequency, if the cancer is caught at its earliest stages, most men will not experience any symptoms and 99 percent of patients live five years or longer after diagnosis.
“As a member of the Atlanta Hawks ownership team and a Black male, I am extremely proud of our partnership with the Prostate Cancer Foundation as I believe our work can truly make a difference in the city of Atlanta,” Hill said in a statement. “With the platform we are afforded, we have a responsibility to be a community leader and this is a great opportunity to educate in a way that could potentially save lives.”
African Americans Are Underrepresented in Cancer Trials
Drugs are safer and more effective for everyone when there is diversity in clinical research, according to the Food and Drug Administration (FDA). Yet, ProPublica reports, many Black people are excluded from important clinical trails for cancer drugs.
African Americans have the highest death rate and shortest survival of any racial and ethnic group in the U.S. for most cancers according to the American Cancer Society.
Despite the high incidence of cancer, findings showed that less than 5 percent of Black patients were included in trials for 24 of the 31 cancer drugs approved since 2015, even though African Americans account for 13.4 percent of the population.
It is suggested that African Americans do not enroll in clinical trials for several reasons, including financial hurdles, logistical challenges and a distrust of the medical system because of past harmful experiences.
Paradoxically, the criteria for admission to clinical trials make it more difficult for African Americans to join. Trials want to enroll “the healthiest sick people they can find,” says Jonathan Jackson, PhD, founding director of the Community Access, Recruitment, and Engagement Research Center at Massachusetts General Hospital. This can often leave African Americans at a disadvantage because they’re more likely to have suffered a stroke or to have high blood pressure or diabetes, among other conditions.
In contrast, they are disproportionately enrolled in clinical trials that are exempt from informed consent requirements, such as testing that takes place in an emergency room setting.
Many have called on the FDA to require pharmaceutical companies to include more minority patients in trials. But according to FDA spokeswoman Gloria Sanchez-Contreras, the agency “does not have the regulatory authority to require specific levels of minority representation in clinical trials.”
New Study to Focus on African Americans
A new study is now underway that will focus on why African Americans have a much higher incidence of prostate cancer. To many people this study is hopefully going to shed light on a problem that has been ignored for a long period of time.
Prostate cancer researchers and experts from across the country are launching a national study focusing on prostate cancer in African American men called the RESPOND study (Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers and Social Stress). The RESPOND Study will be one of the largest studies ever to look at the underlying factors and reasons that put African American men at higher risk for prostate cancer. Over the next 5 years, 10,000 African American men with prostate cancer will be recruited.
Molecular Marker Now Offers Explanation for Increased Incidence of Prostate Cancer in African American Men
While the following information can seem overwhelming, it simply describes how studies have indicated that the primary reasons for the high incidence of prostate cancer in Black men is due to genetic differences that not only make them far more susceptible to being afflicted with prostate cancer, but that it is also a manifests itself in a far more aggressive manner that dramatically increases their chances of dying from the disease.
Evidence for differences between the course and outcome of prostate cancer in African American men has been found in molecular markers. Several studies have been conducted regarding the location of SNPs (single nucleotide polymorphisms) and the differences in their rates of occurrence by race. SNPs are genetic markers that are common to people with prostate cancer.
Approximately 100 genes with SNPs are implicated in increasing men’s susceptibility to prostate cancer. These are especially accurate because SNPs are stable throughout one’s lifetime, so they cannot be affected by extraneous factors such as lifestyle. For example, individuals with a specific SNP (10993994) are at a 1.6 times higher risk of prostate cancer.
17 of the 20 SNPs known to cause prostate cancer are more common in African American men and two of those 17 SNPs are associated with a higher risk of developing a more aggressive form of prostate cancer.
These SNPs are located in the promoter region of what is known as the MSMB gene, which is affected by the protein synthesized in the prostate.
Inflammation is also a known component of cancer and inflammation levels are often related to elevated levels of what are known as C-reactive protein (CRP), and in fact, a recent study showed that elevated CRP levels at the time of diagnosis nearly doubled a patient’s risk for prostate cancer-specific mortality (with a hazard ratio [HR] of 1.88 in multivariate analysis). The authors concluded that the presence of a systemic inflammatory response, at diagnosis, independently predicts poor long-term cancer outcome in patients with localized prostate cancer.
These recent insights provide information that will help physicians conduct tests that may discern the risk level of patients before performing painful and dangerous biopsies.
New Drug in Development Targets Inflammation and Protein Levels
Aneustat is a unique drug formulation that has been the subject of numerous studies that have examined its viability as an effective agent against prostate cancer cells as both a stand-alone medication and as a combination therapy with the most commonly prescribed medications currently in use for the treatment of prostate cancer.
It has had extraordinary results in pre-clinical trials that utilized human prostate tumors and has the potential to offer substantial efficacy, yet has a negligible side effect profile while presenting no known safety risks.
Of even greater importance is that it has been shown to normalize protein levels, which may affect the action of the SNPs, which, as outlined above, are more prominent in Black men. Additionally, Aneustat is known to reduce inflammation, which can both target both the symptomatology and causal factors associated with cancer.
The fact that Aneustat demonstrates a distinct mechanism of action that may influence the specific elements that are common among African Americans with prostate cancer would indicate that a clinical trial that included a substantial African American patient population is warranted.
The various initiatives that have recently been introduced by well-known individuals will hopefully reach the intended audience and raise the level of awareness regarding the high incidence of prostate and increased mortality rate among African American men. This is of great significance because if prostate cancer is detected early the patient has a 98% survival rate. This number falls alarmingly to 26% if it is detected in the later stages. Prostate cancer does not always have symptoms or they can be mistaken for other, less serious conditions, so screening among African American men should be part of a normal check-up among men over the age of 40.
PSA tests, however, can lead to many false positives that necessitate painful and sometimes unnecessary biopsies, but recent developments have provided new evaluation procedures, such as the 4Kscore™ test, that can prevent this unfortunate and dangerous occurrence.
Of even greater importance, however, is that the identification of the genetic factors that are responsible for the high incidence and mortality rates among Black men will allow for the development of new therapies, such as Aneustat, that have a mechanism of action that specifically targets the specific causal factors common among men of African ancestry.