Age-Dependent Occurrence of Prostate Cancer in an African-American Patient Population of Predominantly West Indian Origins
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Abstract
In a prior study of the occurrence of prostate cancer in a unique population of African American patients many of whom have West Indian ancestry, we found that seventy percent of patients screened for prostate were found to have this disease and that, of the seventy percent diagnosed with prostate cancer, 70 percent were found to have high-grade (Gleason score ≥ 7) disease. Overall, therefore, high-grade prostate cancer was found in over 50 percent of all cancers diagnosed, a rate of occurrence that was significantly higher than the corresponding ones for other demographic populations. Since the average age for screening was 65, the same as in other demographic groups, we conjectured that earlier screening of our patients might eliminate many of these high-grade tumors. To validate this hypothesis, we have now examined the rates of occurrence of high-grade prostate cancers in successive age groups, i.e., 40-<50, 50-<60, 60-<70, 70-<80 and >80. Surprisingly, we found that, already in the 50-<60 age group, the frequency of occurrence of high-grade cancers is >50%. (The number of patients in the 40-<50, i.e.,12 and >80, i.e., 6, were too small to be accurately evaluated.) Since the high rate of high-grade cancer occurs in the 50-<60-year group, we conclude that screening for prostate cancer should be performed on our patients at significantly earlier ages such as 40-<50. Also, in view of the expectation that high-grade tumors would increase with increasing age, a second unexpected finding was that the percentage of high-grade tumors was statistically the same at >50 percent in the 50-<60, 60-<70 and 70-<80 age groups. This result could be explained if there was a concurrent increase in low-grade tumors occurring in older patients suggesting that continued, persistent screening is necessary even in advanced age groups. We further found that the mean Gleason score of the 50-<60 and 60-<70 age groups is statistically the same, suggesting that the high-grade tumors are "stable". However, there is a statistically significant increase in Gleason scores between the 70-<80 age group and the two lower age groups which is associated with a large increase in Gleason 9 cancers in the 70-<80 age group and a concurrent, marked decrease in Gleason 7 cancers, suggesting significant recurrent progression of high-grade tumors in this age group.
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References
2. Grizzle WE, Kittle RA, Rais-Bahrami S, Shah E, Adams GW, DeGuenther MS, Kolettis PN, Nix JW, Bryant JE, Chinsky R, Kearns JE, Dehimer K, Terrin N Chang H Gaston SM. Self‐Identified African Americans and prostate cancer risk:West African genetic ancestry is associated with prostate cancer diagnosis and with higher Gleason sum on biopsy. Cancer Med. 2019;8:6915–6922.
3. Woods SE, Messer J, Enge A. The influence of ethnicity on Gleason score. JMH. 2008;5: 314-317.
4. Ugare UG, Bassey IE, Ekanem IA. Analysis of Gleason grade and scores in 90 Nigerian Africans with prostate cancer during the period 1994 to 2004. African Health Sciences 2012; 12: 69 - 73.
5. Hoffman RH. Screening for prostate cancer. UpToDate. 2019. Accessed at https://www.uptodate.com/contents/screening-for-prostate-cancer on March 28, 2019.
6. National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Prostate Cancer Early Detection. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/prostate_detection.pdf on March 28, 2019.
7. National Cancer Institute. Physician Data Query (PDQ). Prostate Cancer Screening. 2019. Accessed at https://www.cancer.gov/types/prostate/hp/prostate-screening-pdq on March 28, 2019.
8. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027-2035.
9. Sheridan TB, Carter HB, Wang W, Landis PB, Epstein JI. Change in prostate cancer grade over time in men followed expectantly for Stage T1C disease. J Urol. 2008; 179: 901–905. Doi:10.1016/j.juro.2007.10.062
10. Warlick C, Feia K, Tomasins J, Iwamoto C, Lindergren B, Risk M. Rate of Gleason 7 or higher prostate cancer on repeat biopsy after a diagnosis of atypical small acinar proliferation. Prostate Cancer Prostatic Dis.2015; 18:255-259. doi:10.1038/pcan.2015.14.
11. Penney K, Stampfer MJ, Jahn JL, Sinoff JA, Flavin R, Rider JR, Finn S, Giovannucci E, Sesso HD, Loda M, Mucci LA, Fiorentino M Cancer Res 2013;73: 5163-5168.
12. Vaderweele DJ, Brown CD, Taxy JB, Gillard M, Hatcher DM Low-grade prostate cancer diverges early from high-grade and metastatic disease. Cancer Sci 2014; 105:1079–1085.
13. Godtman RAG, Kollberg KS, Pihl, C-G, Mansson M, Hugosson J. The association between age, prostate cancer risk, and higher Gleason score in a long-term screening program: results from the Göteborg-1 Prostate Cancer Screening Trial. Eur Urol. 2022;82: 311-317.
14. Huynh-Le M-P, Myklebust TA, Feng CH, Karunamuni R, Johannesen TB, Dale AM, Andreassen OA, Seibert TM. Age dependence of modern clinical risk groups for localized prostate cancerA population-based study. Cancer. 2020; 126:1691-1699.
15. Shah N, Ioffe V. Frequency of Gleason Score 7 to 10 in 5100 elderly prostate cancer patients. Rev Urol. 2016;18:181-187 doi: 10.3909/riu0732.
16. Ji G, Huang C, Song G, Xiong G, Fang D, Wang H, Hao H, Cai L, He Q, He Z, Zhou L. Are the pathological characteristics of prostate cancer more aggressive or more indolent depending upon the patient age? Hindawi BioMed Res International. 2017; Article ID 1438027, 6 pages https://doi.org/10.1155/2017/1438027.