Prostate Cancer: Current Status & Future Directions Unique Impact on Caribbean and African American Men Epidemiology of Prostate Cancer Glen W. McWilliams, MD Chief of Urology James J. Peters Veterans Affairs Medical Center Assistant Professor of Clinical Urology Mount Sinai School of Medicine
American Cancer Society 2009 • • • • • • • •
Most common cancer in American men (skin) Second leading cause of cancer death (lung) 192,280 newly diagnosed cases 27,360 deaths 1 in 6 men diagnosed in his lifetime ~ 2 million US men living CaP 1 in 35 will die 10% cancer-related deaths in men
Relative Survival Rates American Cancer Society 2009
5 year
100%
10 year
91%
15 year
76%
Family History • 1st degree relative affected relative at early age more than doubles 2.5, 5, 11 fold • Affected father • Affected brother
Age • Rare before 40 • Majority screening last decade men >50 • 2/3 case diagnosed over 65
SEER 2002-2006 Data Age Adjusted Incidence 159.3 per 100,000 men Median Age at diagnosis 68
Age 0-20 21-34 35-44 45-54 55-64 65-74 75-84 85+
Percentage 0 0 0.6 8.7 29.0 35.6 21.4 4.7
SEER Cancer Incidence with associated Annual Percentage Change for CaP 1975-2006 Trend
Period
2.6
1975-1988
16.4
1988-1992
-11.4
1992-1995
1.8
1995-2001
-3.4
2001-2006
SEER 2002-2006 Data Age Adjusted Mortality 25.6 per 100,000 men Median Age at Death 80
Age 0-20 21-34 35-44 45-54 55-64 65-74 75-84 85+
Percentage 0 0 0.1 1.4 7.2 20.1 40.9 30.3
SEER US Cancer Mortality with Annual Percentage Change for CaP 1975-2006 Trend
Period
0.9
1975-1987
3.0
1987-1991
-0.6 06
1991 1994 1991-1994
-4.1
1994-2006
Race and Ethnicity • African-American African American men (AAM) highest incidence > White > Hispanic/Latino > Asian-American • AAM more likely to be diagnosed – – – – – –
Higher PSA Higher tumor volume Advanced stage Receive less aggressive therapy Higher recurrence rates Earlier failure
• AAM~ twice the mortality risk
Age Adjusted Incidence by Race 2002-2006 SEER data Race/Ethnicity
Male per 100,000 100 000 men
All Races
159.3
Black
239.8
White
153.0
Hispanic
133 4 133.4
Asian/Pacific Islander
91.1
American Indian/Alaska Native
76.1
Prostate Cancer Incidence Peak 1994-95: • AAM 342/100,000 • EAM 238/100,000
Age@dx 1980s 2000
AAM EAM 70 72 65 68
Age Adjusted Mortality by Race 2002-2006 SEER data Race/Ethnicity
Male per 100,000 100 000 men
All Races
25.6
Black
56.3
White
23.6
Hispanic
19 6 19.6
Asian/Pacific Islander
10.6
American Indian/Alaska Native
20.0
Prostate Cancer Mortality Mortality rates in AAM two fold greater than EAM Age Adjusted Rates/100k Period AAM EAM 2000 68.9 27.8 1992 81.9 36.5
Nationality • Most common North America America, northwestern Europe, Europe Australia and Caribbean Islands • AAM, Caribbean and West Africa (Ghana and Nigeria) • Less common in Asia, Africa, Central America and South America • Screening S i differences diff • Lifestyle • Asians < Asian Americans < white Americans
Prostate Cancer Incidence in Black Men of West African Ancestry 1998-2008 (Odedina et al)
Nigeria Nigeria Nigeria Jamaica Jamaica UK UK UK UK US
127.0 per 100k 61 3 61.3 114.0 304 56.4 647.0 165.5 173.1 139.3 258.3
Genetics • 9 % CaP due to inherited predisposition • Family – 1st degree relative 1, 2, 3 – increased risk 2.5, 5, 11 fold
• Chromosomal linkage 1, 8, 10, 16, 17, 10 and X q , PCAP 1q42-43, q , CAPB • Chromosome 1 :HPC1 1q23-25, 1p36 • Polymorphisms • Expression
Trends in Disease Stage • • • •
PSA Screening detects >75% CaP Decreased advanced and lymph node disease Walter Reed – Decrease adv. dz 15-17%(1988-90) to 4-6% (1996-98)
• DOD Center for Prostate Disease Research 1991 1991-2000 2000 – Surgery men
