Racial disparity in prostate cancer in the African American population with actionable ideas and novel immunotherapies

Abstract

Background: African Americans (AAs) in the United States are known to have a higher incidence and mortality for Prostate Cancer (PCa). The drivers of this epidemiological disparity are multifactorial, including socioeconomic factors leading to lifestyle and dietary issues, healthcare access problems, and potentially tumor biology.Recent findings: Although recent evidence suggests once access is equal, AA men have equal outcomes to Caucasian American (CA) men, differences in PCa incidence remain, and there is much to do to reverse disparities in mortality across the USA. A deeper understanding of these issues, both at the clinical and molecular level, can facilitate improved outcomes in the AA population. This review first discusses PCa oncogenesis in the context of its diverse hallmarks before benchmarking key molecular and genomic differences for PCa in AA men that have emerged in the recent literature.Studies have emphasized the importance of tumor microenvironment that contributes to both the unequal cancer burden and differences in clinical outcome between the races. Management of comorbidities like obesity, hypertension, and diabetes will provide an essential means of reducing prostate cancer incidence in AA men. Although requiring further AA specific research, several new treatment strategies such as immune checkpoint inhibitors used in combination PARP inhibitors and other emerging vaccines, including Sipuleucel-T, have demonstrated some proven efficacy. Conclusion: Genomic profiling to integrate clinical and genomic data for diagnosis,prognosis, and treatment will allow physicians to plan a "Precision Medicine" approach to AA men. There is a pressing need for further research for risk stratification, which may allow early identification of AA men with higher risk disease based on their unique clinical, genomic, and immunological profiles, which can then be mapped to appropriate clinical trials. Treatment options are outlined, with a concise description of recent work in AA specific populations, detailing several targeted therapies, including immunotherapy. Also, a summary of current clinical trials involving AA men is presented, and it is important that policies are adopted to ensure that AA men are actively recruited. Although it is encouraging that many of these explore the lifestyle and educational initiatives and therapeutic interventions, there is much still

Racial Disparity in Utilizing Genetic Testing for Personalized Care of Prostate Cancer

“…Health disparities are often attributed to the lack of socioeconomic resources for minorities that usually reduce accessibility to healthcare 92,95 The difficulties in completing visits for clinical trials can also be limited by the distance to cancer centers and the lack of transportation support. Improving accessibility to studies is an important factor to take into account, perhaps by increasing fund supporting the treatment, housing, and transportation for underrepresented minorities who are enrolled in a study.…”

Long non-coding RNAs and their potential impact on diagnosis, prognosis, and therapy in prostate cancer: racial, ethnic, and geographical considerations

“…• lncRNA candidate biomarkers require analytical and clinical validation to better assess their utility • There is a clear need for more sophisticated computational algorithms which not only accurately predict lncRNAs but also facilitate stringent thresholds and intelligent approaches to triage specific lncRNAs subsets for laboratory-based testing and ultimately clinical implementation. now considered to contribute to these racial differences [63,64].…”

Why do African–American men face higher risks for lethal prostate cancer?

“…The risk of African–American men diagnosed with PCa in their lifetime is 1 in 6, compared with 1 in 8 for non-Hispanic white (NHW) men, and they are twice as likely to die of it once diagnosed [ 1 ]. There is a longstanding debate regarding the cause for these differences, ranging from healthcare access problems, socioeconomic differences resulting in comorbidities that may affect the tumour microenvironment, as well as fundamental differences in tumour biology [ 2 ▪▪ ]. The debate continues with recent evidence supporting the contributions of both socioeconomic issues and tumour biology [ 3 ▪▪ – 5 ▪▪ ].…”