Racial differences in adenocarcinoma of the prostate in North American men

Black men represent a particularly high risk group for the development of prostate cancer. Current recommendations are that all men over age 50 be screened for prostate cancer annually with a digital rectal examination (DRE) and PSA. Moreover, it has been recommended that men in high risk groups, including blacks and men with a family history of prostate cancer, be screened at an earlier age. At the present time, no adequately performed prospective study has demonstrated a reduction in mortality rate attributable to annual prostate cancer screening. Preliminary reports have suggested that the proportion of men with organ confined tumors increases with PSA based screening, and that a reduction in prostate cancer mortality via screening is feasible. In light of these preliminary studies, increased efforts toward patient awareness and PSA screening are certainly warranted in the black community. Hopefully the result of such programs would be to increase the percentage of black men diagnosed with organ confined prostate cancer. However, the etiology of these striking racial differences remains to be defined. To date no consistent data have been presented which can explain these observations. It is likely that multiple factors will be involved including socioeconomic, environmental, dietary, and genetic. Lastly, little is known of the molecular genetic factors, tumor suppressor genes and/or oncogenes, that play a role in prostate cancer in black men. Increased research efforts are needed in order to understand this problem at the molecular level.