Is prostate cancer different in black men? Answers from 3 natural history models.
Is prostate cancer different in black men? Answers from 3 natural history models.
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DOI：
10.1002/cncr.30687
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发表时间：
2017-06-15
期刊：
影响因子：
6.2
通讯作者：
Etzioni R
中科院分区：
文献类型：
--
作者：
Tsodikov A;Gulati R;de Carvalho TM;Heijnsdijk EAM;Hunter-Merrill RA;Mariotto AB;de Koning HJ;Etzioni R
美国黑人男性的前列腺癌发病率比一般人群高得多。发病率差异在多大程度上是由于前列腺癌更普遍，更具侵略性，和/或更频繁地诊断在黑人男性是未知的。根据2005年全国健康访问调查和1975-2000年监测、流行病学和最终结果项目的前列腺癌发病率，我们使用PSA筛查的更新重建，估计了黑人男性和普通人群中三种独立开发的前列腺癌自然史模型。使用估计的模型，我们比较了黑人男性和普通人群的前列腺癌自然史。这些模型预测，到85岁时，30-43%（跨模型范围）的黑人男性患上临床前前列腺癌，风险（相对）比普通人群高28-56%。在有临床前疾病发作的男性中，黑人男性的诊断风险（35-49%）与普通人群（32-44%）相似，但他们在诊断时进展为转移性疾病的风险比普通人群高44-75%。前列腺癌发病模式暗示黑人男性中临床前疾病的发病率较高，转移进展的风险较高。研究结果表明，筛查黑人男性比白色男性更早，并支持进一步研究更积极的筛查政策对黑人男性的利弊权衡。
Black men in the US have substantially higher prostate cancer incidence rates than the general population. The extent to which the incidence disparity is due to prostate cancer being more prevalent, more aggressive, and/or more frequently diagnosed in black men is unknown. We estimated three independently developed models of prostate cancer natural history in black men and in the general population using an updated reconstruction of PSA screening, based on the National Health Interview Survey in 2005, and prostate cancer incidence from the Surveillance, Epidemiology, and End Results program in 1975–2000. Using the estimated models, we compared prostate cancer natural history in black men and in the general population. The models projected that 30–43% (range across models) of black men develop preclinical prostate cancer by age 85 years, a risk that is (relatively) 28–56% higher than in the general population. Among men who have had preclinical disease onset, black men have a similar risk of diagnosis (35–49%) compared with the general population (32–44%), but their risk of progression to metastatic disease by the time of diagnosis is 44–75% higher than in the general population. Prostate cancer incidence patterns implicate higher incidence of preclinical disease and higher risk of metastatic progression among black men. The findings suggest screening black men earlier than white men and support further research into the benefit-harm tradeoffs of more aggressive screening policies for black men.