THE "NEW" PROSTATE CANCER INFOLINK

We are delighted to see a recent paper by Zeigler-Johnson et al. address racial and geographic issues regarding prostate cancer in selected developing countries. While prostate cancer is common around the world, little is actually known about the presentation of the disease in West Africa and India compared to the United States.

Zeigler-Johnson et al. recruited prostate cancer patients from four hospital-based populations. The sample included 338 African-Americans, 1,265 European-Americans, 122 Asian Indians, and 72 Senegalese. Questionnaire and medical record data were collected on each participant.

The authors found significant differences in age at diagnosis, BMI, and PSA levels across the groups. They also noted the following:

• Senegalese and Indian men had a higher probability of high stage (T3/T4) disease compared to US men.
• Gleason grade was significantly higher in Asian Indians compared to other populations.
• African-Americans, Senegalese, and Asian Indians had a significantly higher probability of metastatic disease compared to European-Americans.
• The odds ratios for metastasis were consistently higher in Asian Indians compared to American cases.
• As only 19/72 Senegalese were assessed for metastasis, their odds ratio could not be determined for metastasis.

As the authors observe, these results suggest significant geographical and ethnic differences in the presentation of prostate cancer. Men in developing countries tend to present with more advanced forms of disease compared to US men. Identifying risk factors for advanced disease may help to decrease the rate of poor prostate cancer outcomes and associated mortality worldwide.