scholarly journals A review of new hormonal therapies for prostate cancer in black men: is there enough data?

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthias E. Meunier ◽  
Pascal Blanchet ◽  
Yann Neuzillet ◽  
Thierry Lebret ◽  
Laurent Brureau
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Receptor ◽  
Black Men ◽  
White Men ◽  
Molecular Characteristics ◽  
Black Patients ◽  
First Results ◽  
Black Populations ◽  
Hormonal Therapies

Abstract Background Prostate cancer among black men is known to have specific molecular characteristics, especially the androgen receptor or enzymes related to the androgen metabolism. These targets are keys to the action of new hormonal therapies. Nevertheless, literature has a lack of data regarding black men. We aimed to gather the available literature data on new hormonal therapies among black populations. Methods We conducted a literature review from the PubMed / MEDLINE database until October 2020. All clinical studies of new hormonal therapies and black populations, regardless of methodology, were included. Results Four studies provided data on new hormonal therapies in black populations. Three studies reported a PSA decline in black patients treated with Abiraterone, higher in black men than in white men. Overall survival also appears to be higher in black patients treated with Abiraterone only or first. Conclusion Few articles have evaluated the effectiveness and safety of use of these treatments among black populations. The first results seem to show that Abiraterone can provide a benefit in overall survival in black populations. Prospective studies are needed to answer these questions in the future.

scholarly journals Overall Survival of Black and White Men With Metastatic Castration-Resistant Prostate Cancer Treated With Docetaxel

2019 ◽  
Vol 37 (5) ◽  
pp. 403-410 ◽  
Author(s):  
Susan Halabi ◽  
Sandipan Dutta ◽  
Catherine M. Tangen ◽  
Mark Rosenthal ◽  
Daniel P. Petrylak ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Black Men ◽  
Performance Status ◽  
Specific Antigen ◽  
White Men ◽  
Phase Iii ◽  
Castration Resistant Prostate Cancer ◽  
Black And White ◽  
Castration Resistant

Purpose Several studies have reported that among patients with localized prostate cancer, black men have a shorter overall survival (OS) time than white men, but few data exist for men with advanced prostate cancer. The primary goal of this analysis was to compare the OS in black and white men with metastatic castration-resistant prostate cancer (mCRPC) who were treated in phase III clinical trials with docetaxel plus prednisone (DP) or a DP-containing regimen. Methods Individual participant data from 8,820 men with mCRPC randomly assigned in nine phase III trials to DP or a DP-containing regimen were combined. Race was based on self-report. The primary end point was OS. The Cox proportional hazards regression model was used to assess the prognostic importance of race (black v white) adjusted for established risk factors common across the trials (age, prostate-specific antigen, performance status, alkaline phosphatase, hemoglobin, and sites of metastases). Results Of 8,820 men, 7,528 (85%) were white, 500 (6%) were black, 424 (5%) were Asian, and 368 (4%) were of unknown race. Black men were younger and had worse performance status, higher testosterone and prostate-specific antigen, and lower hemoglobin than white men. Despite these differences, the median OS was 21.0 months (95% CI, 19.4 to 22.5 months) versus 21.2 months (95% CI, 20.8 to 21.7 months) in black and white men, respectively. The pooled multivariable hazard ratio of 0.81 (95% CI, 0.72 to 0.91) demonstrates that overall, black men have a statistically significant decreased risk of death compared with white men ( P < .001). Conclusion When adjusted for known prognostic factors, we observed a statistically significant increased OS in black versus white men with mCRPC who were enrolled in these clinical trials. The mechanism for these differences is not known.

scholarly journals GSTP1 positive prostatic adenocarcinomas are more common in Black than White men in the United States

2020 ◽  
Author(s):  
Igor Vidal ◽  
Qizhi Zheng ◽  
Jessica L. Hicks ◽  
Jiayu Chen ◽  
Elizabeth A. Platz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Black Men ◽  
Cpg Island ◽  
Molecular Subtype ◽  
White Men ◽  
The United States ◽  
Dna Hypermethylation ◽  
Black Patients ◽  
Prostate Cancers ◽  
White Patients

GSTP1 is a member of the Glutathione-S-transferase (GSTS) family silenced by CpG island DNA hypermethylation in 90-95% of prostate cancers. However, prostate cancers expressing GSTP1 have not been well characterized. We used immunohistochemistry against GSTP1 to examine 1673 primary prostatic adenocarcinomas on TMAs with redundant sampling from the index tumor from prostatectomies. GSTP1 protein was positive in at least one TMA core in 7.7% of cases and in all TMA cores in 4.4% of cases. The percentage of adenocarcinomas from Black patients who had any GSTP1 positive TMA cores was 14.9%, which was 2.5 times higher than the percentage from White patients (5.9%; P < 0.001). Further, the percentages of tumors from Black patients who had all TMA spots positive for GSTP1 (9.5%) was 3-fold higher than the percentage from White patients (3.2%; P<0.001). The increased percentage of GSTP1 positive cases in Black men was present only in ERG positive cases. By in situ hybridization, GSTP1 mRNA expression was concordant with protein staining, supporting the lack of silencing of at least some GSTP1 alleles in GSTP1-positive tumor cells. This is the first report revealing that the GSTP1-positive prostate cancer subset is substantially over-represented among prostate cancers from Black compared to White men. This observation should prompt additional studies to determine whether GSTP1 positive cases represent a distinct molecular subtype of prostate cancer and whether GSTP1 expression could provide a biological underpinning for the observed disparate outcomes for Black men.

scholarly journals Laboratory eligibility criteria as potential barriers to participation by black men in prostate cancer clinical trials.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 73-73
Author(s):  
Marie Vastola ◽  
David Dewei Yang ◽  
Brandon Arvin Virgil Mahal ◽  
Vinayak Muralidhar ◽  
Christopher S. Lathan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Clinical Trials ◽  
Renal Function ◽  
Black Men ◽  
Racial Differences ◽  
Cancer Clinical Trials ◽  
Eligibility Criteria ◽  
Black Patients ◽  
Incidence And Mortality

73 Background: Eligibility criteria may disproportionately affect black patients and contribute to their underrepresentation in clinical trials. We studied this potential barrier by examining clinical trials in prostate cancer, a disease in which black men face higher incidence and mortality. Specifically, we investigated the use of serum creatinine (sCr) alone instead of race-adjusted measurements for renal function, and the use of an absolute neutrophil count (ANC) threshold that could exclude men with benign ethnic neutropenia, which afflicts 6.7-8% of black patients and could lead to the exclusion of patients despite having healthy immune systems. Methods: We identified 401 interventional prostate cancer clinical trials with an overall survival endpoint. The list of trials was collected on January 16, 2017 from clinicaltrials.gov using the following criteria – study type: interventional studies; conditions: prostate cancer; interventions: drug; outcome measures: overall survival. Characteristics gathered from each trial included sponsor type, phase, accrual goal, start year, and toxicity. Results: Overall, 47.9% (192) of these trials used either sCr alone and/or required participants to have ANC ≥1.5×109 cells/L. Specifically, 25.2% (101) of the trials used sCr alone to determine eligibility, and 41.4% (166) of the trials required patients to have an ANC ≥1.5×109 cells/L. Conclusions: Of clinical trials in prostate cancer, 47.9% used criteria that disproportionately excluded black patients. The reevaluation of these two eligibility criteria could improve minority trial enrollment. First, lowering the ANC cutoff for patients with benign ethnic neutropenia would increase the number of eligible black participants, as 89% of these patients have an ANC ≥1.0×109 cells/L. Second, using race-adjusted equations for renal function would take into account racial differences in creatinine. While adopting race-based differences in trial criteria may add slight logistical challenges when ensuring patients meet trial eligibility, these adjustments would prevent healthy patients from being excluded solely because of benign laboratory differences caused by their race.

Promotion of prostate cancer screening equity: A quality improvement education initiative.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 140-140
Author(s):  
Kristen Stevens Hobbs ◽  
Thomas Farrington ◽  
Andrew McGlone ◽  
Roxanne Leiba Lawrence ◽  
Ginny Jacobs ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Improvement ◽  
Black Men ◽  
Prostate Cancer Screening ◽  
Fee For Service ◽  
Assessment Data ◽  
Black Patients ◽  
Black Populations ◽  
Practice Assessment ◽  
Zip Code

140 Background: Black men are disparately affected by prostate cancer (PC). They are more likely to develop PC and at an earlier age when the disease is more advanced at diagnosis. As a result, Black men are two to three times more likely to die from PC than white men. Given these disparities, experts increasingly promote screening for PC in Black men at a younger age. Methods: To inform implementation of a quality improvement education (QIE) project in three primary care practices in Maryland, a zip code analysis of the prevalence of PC was performed. Maryland practices were selected due to higher rates of PC in regions of the state and significant Black populations (Table). The QIE initiative started with a baseline practice assessment survey (including information on panel size, patient demographics, PC screening/treatment approaches, and barriers) and an analysis of current PC screening rates. Health system leaders and champions from the practice sites received training on patient-centered conversations with high-risk Black patients and concerning QIE planning. The champions developed rapid cycle improvement plans to implement increased screening using a patient-oriented online educational platform ( Dr. PSA ), as well as posters, and placards for patient education. Results: The overall national prevalence of PC in Medicare Fee-for-Service Program beneficiaries in 2018 was 2.65%. For Black beneficiaries the overall prevalence was 2.89%. Prevalence for beneficiaries in specific Maryland zip codes are detailed in Table. *Data not available; Source: NMQF Prostate Cancer Index Baseline practice assessment data revealed that patient panels ranged from 4,000 to 58,163 patients, with Black patients accounting for 50% or more of two of the practices and 25 to 50% of the third practice. Barriers to screening identified include financial issues, insurance restrictions, and lack of knowledge about PC and screening. Baseline screening rates are approximately 75%. Conclusions: Zip code prevalence analysis and baseline practice assessment data confirmed the relevance of implementing a QIE initiative in the three selected sites. Through a mixed-methods evaluation study, practice staff knowledge, attitudes, and self-reported practices will be assessed pre- and post-QIE initiative to assess impact of the initiative and determine opportunities for further improvement in PC screening practices.[Table: see text]

scholarly journals Next-generation androgen receptor inhibitors in non-metastatic castration-resistant prostate cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592097813
Author(s):  
Pernelle Lavaud ◽  
Clément Dumont ◽  
Constance Thibault ◽  
Laurence Albiges ◽  
Giulia Baciarello ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Receptor ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Next Generation ◽  
Castration Resistant Prostate Cancer ◽  
Free Survival ◽  
Castration Resistant ◽  
Recent Advances

Until recently, continuing androgen deprivation therapy (ADT) and closely monitoring patients until evolution towards metastatic castration-resistant prostate cancer (CRPC) were recommended in men with non-metastatic CRPC (nmCRPC). Because delaying the development of metastases and symptoms in these patients is a major issue, several trials have investigated next-generation androgen receptor (AR) axis inhibitors such as apalutamide, darolutamide, and enzalutamide in this setting. This review summarizes the recent advances in the management of nmCRPC, highlighting the favourable impact of next-generation AR inhibitors on metastases-free survival, overall survival and other clinically meaningful endpoints.

Earlier use of androgen receptor-axis-targeted drugs may improve overall survival in patients with non-metastatic castration-resistant prostate cancer

The Prostate ◽  
2018 ◽  
Vol 78 (10) ◽  
pp. 766-772 ◽  
Author(s):  
Keiichiro Mori ◽  
Takahiro Kimura ◽  
Kagenori Ito ◽  
Hajime Onuma ◽  
Masatoshi Tanaka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Receptor ◽  
Targeted Drugs ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant

scholarly journals The prevalence of prostate cancer in Brazil is higher in Black men than in White men: systematic review and meta-analysis

2012 ◽  
Vol 38 (4) ◽  
pp. 440-447 ◽  
Author(s):  
Frederico R. Romero ◽  
Antonio W. Romero ◽  
Rui Manuel S. de Almeida ◽  
Renato Tambara Filho
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Black Men ◽  
Meta Analysis ◽  
White Men

Molecular Biology Underlying the Clinical Heterogeneity of Prostate Cancer: An Update

2009 ◽  
Vol 133 (7) ◽  
pp. 1033-1040 ◽  
Author(s):  
A. Craig Mackinnon ◽  
Benjamin C. Yan ◽  
Loren J. Joseph ◽  
Hikmat A. Al-Ahmadie
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Molecular Biology ◽  
Gene Rearrangement ◽  
Molecular Characteristics ◽  
Early Event ◽  
Ablation Therapy ◽  
Androgen Ablation ◽  
Development Of Resistance ◽  
Prostate Cancers

Abstract Context.—Recent studies have uncovered a number of possible mechanisms by which prostate cancers can become resistant to systemic androgen deprivation, most involving androgen-independent reactivation of the androgen receptor. Genome-wide expression analysis with microarrays has identified a wide array of genes that are differentially expressed in metastatic prostate cancers compared to primary nonrecurrent tumors. Recently, recurrent gene fusions between TMPRSS2 and ETS family genes have been identified and extensively studied for their role in prostatic carcinoma. Objective.—To review the recent developments in the molecular biology of prostate cancer, including those pertaining to the androgen receptor and the newly identified TMPRSS2-related translocations. Data Sources.—Literature review and personal experience. Conclusions.—Prostatic adenocarcinoma is a heterogeneous group of neoplasms with a broad spectrum of pathologic and molecular characteristics and clinical behaviors. Numerous mechanisms contribute to the development of resistance to androgen ablation therapy, resulting in ligand-independent reactivation of the androgen receptor, including amplification, mutation, phosphorylation, and activation of coreceptors. Multiple translocations of members of the ETS oncogene family are present in approximately half of clinically localized prostate cancers. TMPRSS2:ERG gene rearrangement appears to be an early event in prostate cancer and is not observed in benign or hyperplastic prostatic epithelium. Duplication of TMPRSS2:ERG appears to predict a worse prognosis. The relationship between TMPRSS2:ERG gene rearrangement and other morphologic and prognostic parameters of prostate cancer is still unclear.

scholarly journals Comorbidities and the Risk of Late-Stage Prostate Cancer

2006 ◽  
Vol 6 ◽  
pp. 2460-2470 ◽  
Author(s):  
Steven T. Fleming ◽  
Kathleen McDavid ◽  
Kevin Pearce ◽  
Dmitri Pavlov
Keyword(s):  
Prostate Cancer ◽  
Substance Abuse ◽  
Black Men ◽  
Late Stage ◽  
White Men ◽  
Cardiac Conduction ◽  
Conduction Disorders ◽  
Stage Disease ◽  
Severe Renal Disease ◽  
Artery Disease

The degree to which comorbidities affect the diagnosis of prostate cancer is not clear. The purpose of this study was to determine how comorbidities affect the stage at which prostate cancer is diagnosed in elderly white and black men. We obtained data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute merged with Medicare claims data. For each patient, we estimated associations between stage of disease at diagnosis and each of the 27 comorbidities. The sample included 2,489 black and 2,587 white men with staged prostate cancer. Coronary artery disease, benign hypertension, and dyslipidemia reduced the odds of late-stage prostate cancer. A prior diagnosis of peripheral vascular disease, severe renal disease, or substance abuse increased the odds of being diagnosed with late-stage disease. The study shows some effect modification by race, particularly among white men with substance abuse, cardiac conduction disorders, and other neurologic conditions. The strongest predictors of late-stage prostate cancer diagnosis for both white and black men were age at diagnosis of at least 80 years and lack of PSA screening. Comorbidities do affect stage at diagnosis, although in different ways. Four hypotheses are discussed to explain these findings.

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