Racial Differences in Prostate Cancer: Influence of Health Care Interaction and Host and Tumor Biology Public Abstract

Background Prostate cancer is the most common cancer in men and the second leading cause of cancer mortality. In men younger than 65 years of age, the prostate cancer mortality rate for African Americans is 3.1 times that of Caucasian Americans. In men 65 years of age and older, the prostate cancer mortality rate for African Americans is 2.3 times that of Caucasian Americans. Three potential reasons have been suggested frequently to explain the disproportionate mortality from prostate cancer in African Americans compared to Caucasian Americans. First, African Americans present more often with advanced, incurable prostate cancer because of more limited access to health care due to socioeconomic status resulting in decreased participation in early detection programs. Second, once diagnosed with potentially curable prostate cancer, effective treatments are chosen less often by African Americans; for example, African Americans have been reported more likely to observe prostate cancer. Finally, prostate cancer is biologically more aggressive in African Americans than Caucasian Americans. Among men treated by radical prostatectomy, race alone was found prognostically important when age, Gleason grade and clinical stage were controlled in multivariate analysis.