Not only does prostate cancer tend to start at a younger age, and to be more aggressive, in some Black men: it also tends to start in a different part of the prostate! And not only is it often in a different part (the anterior region of the prostate, behind the urethra): it’s a part that’s more difficult to reach, and easier to miss, with a tiny biopsy needle.
What can you do about this? PCF-funded physician-scientist Kosj Yamoah, M.D., Ph.D., radiation oncologist and cancer epidemiologist at Moffitt Cancer Center in Tampa, Florida, offers this advice: “An MRI and perhaps an additional blood or urine test, to discover or rule out aggressive cancer, will help even the playing field for Black men – even for Black men who are thought to have lower-risk disease, who may want to be on active surveillance.” Is it truly safe to be on active surveillance? Do you truly have low-risk disease – or was there more intermediate- or even high-risk disease hidden in the prostate that was not captured by the biopsy needle? “Active surveillance works well – as long as patients are staged correctly.”
Here’s another difference: Black men seem to respond better to some treatments than other men! Research by Yamoah and colleagues has shown that Provenge (Sipuleucel-T), an immunotherapy drug currently approved for men with metastatic prostate cancer, is more effective in African American men than in other men. Many Black men “seem to have an immune microenvironment enriched for immunosuppressive biomarkers,” says Yamoah. “Also, in these men, prostate cancer tumors may be a bit more sensitive to radiation. We are seeing something in clinical trials: that medications like Provenge, and in some instances radiation and ADT, seem to benefit Black men more than white men, as measured by longer disease-free intervals and longer survival.” This suggests, he adds, that “maybe there is some component of a distinct biological subtype that favors certain treatments in Black men; it’s a paradigm shift!”
Encouraging results from several studies now under way will help oncologists “tailor treatments appropriately with personalized medicine, based on individual patients’ biology. This may be leading to a change in the way we see metastatic disease, that will convert it into a chronic disease. This is all emerging; it’s all new stuff.”