If you are a man of African ancestry, prostate cancer needs to be on your radar.  This is because, of all the men in the world, you are in the group that prostate cancer hits the hardest.  Prostate cancer is different in you than it is in other men.  It can be more serious.

Know Your Genes “Genetic inheritance – your genes – actually discriminate against a man biologically, biochemically, and genetically,” says oncologist Jonathan W. Simons, M.D., President and CEO of the Prostate Cancer Foundation. “You may be white, but you may have an identical bad gene pattern to someone who identifies as African American.”  Simons hopes to be able to fund research to “really intensify our study of men of African descent, because the genetic differences in prostate cancer in these men are under-funded, underappreciated, and under-communicated. “This is independent of poverty – poor medical care -- or whatever carcinogens a man might have been exposed to.   This is genes, not environment.  It’s what you got from your parents and your grandparents that you can’t help.  If we can understand this more aggressive form of prostate cancer, it is going to help all men.”  

This is not fear-mongering; it’s the stark truth:  You are not only more likely to be diagnosed with prostate cancer, but also to have a more aggressive form that needs to be treated.  You are twice as likely to die of prostate cancer as a man of a different heritage.  So if you are a man of African ancestry and you are diagnosed with prostate cancer, you will more likely need to go after it with curative treatment – surgery or radiation.  Active surveillance may not be the best option for you.  And you need to get a baseline PSA and prostate exam starting at age 40.  

“African American men have a one-third higher chance of having more aggressive cancer than the biopsy suggests,” says Edward Schaeffer, M.D., Ph.D., Chairman of Urology at Northwestern University.  This means that if you are diagnosed with cancer and have surgery to remove it, when the pathologist looks at the cancer under the microscope, it very well might turn out to be of a higher grade, or there may be more of it than expected.  More worrisome: “when these men need surgery, they are more likely to need additional adjuvant treatment, or to experience a recurrence of cancer, compared to Caucasian men.  Biologically, their cancers are different.”  Schaeffer is a pioneer in this area and what he has learned, and is actively continuing to study, may save your life.   

One of the reasons why Schaeffer’s work is so groundbreaking: He noticed differences in the cancers of his patients who were African American or Caucasian; then he began to look specifically at prostate cancer in black men to figure out why this might be.  “Almost everything that we understand about prostate cancer is based on data from Caucasians,” he says.

 “Our understanding of the presentation, natural history and biology of prostate cancer is based predominantly on research done on the cancer of Caucasian men.”  

Many of the assumptions that scientists made about prostate cancer – and even some of the markers developed to test for prostate cancer – don’t hold up in black men.

To begin to unravel this important problem, Schaeffer teamed up with PCF young investigator Kosj Yammoah.  “We both knew there are a lot of unknowns about prostate cancer biomarkers in men of African ancestry,” says Schaeffer.  “We decided to look to see how 20 different established molecular markers for prostate cancer “performed in African American men compared to Caucasian men.  Surprisingly, we found that only about one-third of them were the same between whites and blacks.”

But in a striking development, “we also found that about one-third of these markers behaved in inverse fashion in black men compared to Caucasians.”  This means that a marker that goes up in white men to signal cancer actually goes down in men of African ancestry when cancer or aggressive cancer is present.  “In men of African ancestry, a lot of established biomarkers are not the same as the established markers in Caucasians.”  

“The clinical implications for the behaviors of biomarkers and how they differ are unknown.  We can certainly extrapolate that how we follow cancer in white patients may not be the best way to do it in men of African ancestry.”

One important thing you can do:  Take Vitamin D.  “African Americans are very often Vitamin D deficient,” says Schaeffer.  “Their body does not absorb that UVB radiation.”  And this is important, because “Vitamin D is like a fire retardant,” explains oncologist Jonathan Simons, M.D., President and CEO of the Prostate Cancer Foundation.  “It has an optimum protect effect against cancer, and it’s really important in men between their 20s and 40s – because in the absence of fire retardant, more embers can get lit.  Cancer can start more easily.”

Vitamin D “is a hormone but we call it a vitamin,” Simons adds.  It has a powerful antitumor effect.  In laboratory studies, vitamin D has been shown to slow down the growth of cancer cells; it also makes them less aggressive.   In people, most vitamin D – 90 percent of it – comes from exposure to the sun.  When the sun’s rays hit our skin, vitamin D converts into an active form (called 1,25 dihydroxyvitamin D) that helps keep cells healthy and protects against cancer.

A simple blood test can help here, says Schaeffer.  “If you check the levels of vitamin D in the blood, having a lower vitamin D level is a predictor of having a positive or negative biopsy.  If a man of African ancestry has a lower vitamin D level, the chances of having a cancer detected on biopsy are even higher.”  Schaeffer recommends having your vitamin D levels checked by your primary care doctor.  “Your vitamin D levels have a big impact on a lot of things, including bone health, risk of heart disease and stroke — and being diagnosed with prostate cancer.’’  How much should you take?  About 2,000 IU (International Units) daily is probably enough, but if your levels are low, your doctor may recommend a higher dose.

Know Your Genes “Genetic inheritance – your genes – actually discriminate against a man biologically, biochemically, and genetically,” says oncologist Jonathan W. Simons, M.D., President and CEO of the Prostate Cancer Foundation. “You may be white, but you may have an identical bad gene pattern to someone who identifies as African American.”  Simons hopes to be able to fund research to “really intensify our study of men of African descent, because the genetic differences in prostate cancer in these men are under-funded, underappreciated, and under-communicated. “This is independent of poverty – poor medical care -- or whatever carcinogens a man might have been exposed to.   This is genes, not environment.  It’s what you got from your parents and your grandparents that you can’t help.  If we can understand this more aggressive form of prostate cancer, it is going to help all men.”  

Terms to know from this article:

Active Surveillance

Active surveillance is an option offered to patients with very low-risk prostate cancer (low grade, low stage, localized disease). Patients are monitored carefully over time for signs of disease progression. A PSA blood test and digital rectal exam (DRE) and prostate biopsy are performed at physician-specified intervals. Signs of disease progression will trigger immediate active treatment.

Biopsy

The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

Pathologist

A doctor who identifies diseases by studying cells and tissues under a microscope.

Oncologist

A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

Hormone

A chemical made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in a laboratory.

PSA

prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.

Grade

The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

Janet Farrar Worthington is an award-winning science writer and has written and edited numerous health publications and contributed to several other medical books.

In addition to writing on medicine, Janet also writes about her family, her former life on a farm in Virginia, her desire to own more chickens, and whichever dog is eyeing the dinner dish.