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June 14, 2014
The African American Prostate Cancer Crisis in
Numbers
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The Numbers

• 1
• Prostate cancer is the most commonly diagnosed
  cancer in African-American men.
• African Americans have the highest rate of
  prostate cancer diagnosis compared to all other
  men.
• African Americans have the highest prostate
  cancer death rate of all men.
• The African American prostate cancer death rate
  disparity is the highest for any type of major
  cancer.  

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Prostate Cancer Incidence Mortality by Race
2009 
(Excerpted from National Cancer Institute
publication State Cancer Profiles)Estimated New
Cases 241,740Estimated Deaths 28,170
Source National Cancer InstituteSEER Stat Fact
Sheet Prostate 2012per 100,000 men per year
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Prostate Cancer and African-American Men

• 2 
• Prostate cancer is the 2nd leading cause of
  cancer-related deaths among black men. 
• Black men are more than twice as likely to die of
  prostate cancer. 
• 20   
• 1 in 5 (20) African-American men will be
  diagnosed with prostate cancer in their lifetime.
• 37   
• Prostate cancer accounts for approximately 37 of
  all cancers among Black men.  
• 4,980
• An estimated 4,980 deaths occurred among black
  men from prostate cancer in 2013. 
• 35,430
• An estimated 35,430 black men received prostate
  cancer diagnoses in 2013.

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Lifetime Probability () of Developing Invasive
Cancers by Race and Sex, US, 2007-2009
American Cancer Society. Cancer Facts and Figures
for African Americans 2013-2014. Atlanta
American Cancer Society.
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Lifetime Probability () of Dying from Invasive
Cancers by Race and Sex, US, 2007-2009
American Cancer Society. Cancer Facts and Figures
for African Americans 2013-2014. Atlanta
American Cancer Society.
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Leading Sites of New Cancer Cases and Deaths
among African Americans, 2013 Estimates
Estimated New Cases
Estimated New Deaths
Source 2013, American Cancer Society,
Surveillance and Health Services Research
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States with the Highest African-American
Prostate Cancer Death Rates( 2005 2009 )
Rates are per 100,000 population and age -
adjusted to the 2000 US standard population
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Focus on the Progress

• 40
• The African American prostate cancer death rate
  declined by more than 40 from 1992 to 2010.
• 50
• Cancer deaths among African-American men aged
  40-49 decreased by 50 from 1991 to 2010 (faster
  than all other groups).
• This progress was made during a period of
  emphasis on early detection screening (PSA and
  DRE testing).
• Early detection efforts among African Americans
  now equal to whites.

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Prostate Cancer Death Rates by Race and
Ethnicity, U.S., 19992010
Mortality source U.S. Mortality Files,
National Center for Health Statistics,
CDC.Rates are per 100,000 and are age-adjusted
to the 2000 U.S. standard population (19 age
groups Census P25-1130). Death rates cover 100
of the U.S. population.
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Prostate Cancer Survival and Stage Distribution

• The overall 5-year relative survival rate among
  African Americans is 96 to nearly 100 among
  whites.
• Ninety-one percent of all prostate cancers among
  African Americans are diagnosed at a local or
  regional stage, compared to 93 in whites.
• The 5-year relative survival rate for African
  Americans whose tumors are diagnosed at these
  early stages approaches 100.
• Among African American men, the 5-year survival
  rate drops to 28 when the cancer has spread
  to distant sites.

American Cancer Society. Cancer Facts and Figures
for African Americans 2013-2014. Atlanta
American Cancer Society.
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Imminent Risks to Further Progress

• De-emphasis on Early Detection Testing
• In 2012, the United States Preventive Services
  Taskforce recommended that doctors stop PSA
  screening regardless of age, race, and family
  history, unless a man shows symptoms.
• This recommendation has resulted in a decrease in
  PSA testing.
• These effects were more immediate and pronounced
  in the urban/academic setting, and more gradual
  in suburban and rural settings
• Source Aslanai, A. et al. (2013 December 14).
  The Impact of Recent Screening Recommendations on
  Prostate Cancer Screening in a Large Health Care
  System. Journal of Urology.

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The Prostate Cancer Conundrum

• A ten year decline in prostate cancer deaths
• -versus-
• Concerns about over-diagnosis and over-treatment
• Based on clinical trials that included average
  risk white men
• Clinical Trials and Research Studies
• PSA clinical trials did not include
  African-American participants
• Impossible to know the African-American response
• Research indicates African Americans are
  diagnosed at an earlier stage and with more
  advanced disease progression.

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PHENs Position

• Stay the course that produced progress
• Focus on reducing over-treatment
• New tests are now available to help men determine
  whether treatment or active surveillance is the
  best course
• Increase education and awareness outreach

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PHEN Early Detection Guidance

1. Baseline PSA testing for African American and
   other men deemed to be at high risk for prostate
   cancer is suggested beginning at age 40 for
   predicting their future risk of prostate cancer.
2. PSA testing should not be considered on its own,
   but rather as part of a multivariable approach to
   early prostate cancer detection.
3. A prostate cancer diagnosis must be uncoupled
   from prostate cancer interventionBased on
   PHENs Consensus Statement, September 2013

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Knowledge is the Best Defense Against Prostate
Cancer
Thank you for joining us!