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Asian Race and Risk of Prostate Cancer: Results from the REDUCE Study
Adriana C Vidal1, Taofik Oyekunle2,3, Tom Feng4
1Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Center for Integrated Research on Cancer and Lifestyle, Los Angeles, California. adriana.vidal@cshs.org.
Insights
Asian men had a lower prostate cancer diagnosis rate compared to Caucasian men in the REDUCE study. This suggests potential biological, genetic, or lifestyle factors contribute to lower prostate cancer risk in Asian populations.
Area of Science:
- Urology
- Oncology
- Epidemiology
Background:
- Global prostate cancer incidence is lower in Asian men than Caucasian men.
- The reasons for this disparity, including screening differences, are not fully understood.
- The Reduction by Dutasteride of Cancer Events (REDUCE) study investigated prostate cancer diagnosis rates across racial groups.
Purpose of the Study:
- To examine the association between Asian race and prostate cancer diagnosis.
- To compare prostate cancer diagnosis rates between Asian and Caucasian men in the REDUCE trial.
- To explore potential factors contributing to observed racial differences in prostate cancer incidence.
Main Methods:
- Analysis of data from the 4-year, multicenter, randomized REDUCE trial.
- Inclusion of men aged 50-75 with PSA 2.5-10 ng/mL and negative prestudy biopsy.
- Logistic regression used to test the association between Asian/Caucasian race and prostate cancer diagnosis, adjusting for confounders.
Main Results:
- Asian men (1.8%) had lower BMI and smaller prostate volumes than Caucasian men (71%).
- Asian men were equally likely to undergo on-study biopsies as Caucasian men.
- After adjusting for confounders, Asian men showed a significantly lower likelihood of prostate cancer diagnosis (OR = 0.49; P = 0.016).
Conclusions:
- Asian race was associated with a lower prostate cancer diagnosis in the REDUCE study, where biopsies were largely PSA-independent.
- Findings suggest that biological, genetic, and/or lifestyle factors may contribute to the lower prostate cancer risk observed in Asian men.
Background:
Global prostate cancer incidence rates are lower in Asian men than Caucasian men. Whether this is the result of less screening in Asian men remains to be determined. We examined whether Asian race was associated with prostate cancer diagnosis in the Reduction by Dutasteride of Cancer Events (REDUCE) study.
Methods:
REDUCE was a 4-year, multicenter, randomized trial of dutasteride versus placebo for prostate cancer prevention among men who underwent prostate-specific antigen (PSA)-independent biopsies at 2 and 4 years. Eligible men were ages 50 to 75 years, had PSA between 2.5 and 10 ng/mL, and a negative prestudy prostate biopsy. We tested the association between Asian and Caucasian race and prostate cancer diagnosis using logistic regression.
Results:
Of 8,122 men in REDUCE, 5,755 (71%) were Caucasian and 105 (1.8%) were Asian. Asians had lower body mass index (24.8 vs. 26.9 kg/m2, P < 0.001), had smaller prostate volume (35.0 vs. 43.5 cc, P < 0.001), and were less likely to have abnormal digital rectal exams (P = 0.048), but were similar in baseline age, PSA, family history of prostate cancer, and smoking status compared with Caucasian men (all P ≥ 0.164). Asian men were equally likely to receive any on-study biopsy compared with Caucasian men (P = 0.634). After adjusting for potential confounders, Asian men were less likely to be diagnosed with prostate cancer during the 4-year study (OR = 0.49; 95% confidence interval, 0.28-0.88; P = 0.016), compared with Caucasian men.
Conclusions:
In REDUCE, where all men underwent biopsies largely independent of PSA, Asian race was associated with lower prostate cancer diagnosis.
Impact:
These findings suggest that lower prostate cancer risk in Asian men may be due to biological, genetic, and/or lifestyle factors.
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