UMMC Radiation Oncology, 2500 N State St, Jackson, MS 39216, USA.
G.V. (Sonny) Montgomery VA Medical Center Radiation Oncology, 1500 E Woodrow Wilson Ave, Jackson, MS 39216.
J Natl Med Assoc. 2020 Oct;112(5):448-453. doi: 10.1016/j.jnma.2018.10.010. Epub 2018 Nov 6.
Prostate cancer is the most common form of cancer, other than skin cancers, in American men and the second leading cause of cancer deaths. In 2012, the US Preventative Task Force recommended against the prostate specific antigen-based screening for prostate cancer, regardless of race or age, due to overtreatment of low-risk disease and lack of impact on disease outcomes. In African-American men, however, the incidence of prostate cancer is almost 60% higher and the mortality rate is two- to three-times greater than that of Caucasian men. In the subpopulation of African-American veterans, many have been exposed to chemicals that increase incidence of high-risk prostate cancer. The yearly total number of veterans with prostate cancer based on quantification is 3471.9, and the total number of annual prostate cancer deaths is 556. Considering these facts, we examine whether or not it is appropriate to screen African-American veteran males for prostate cancer. Previously, we reviewed data on African-Americans in the general population. We concluded that new guidelines needed to be implemented for screening African-Americans. Here we review the pertinent issues related to African-American veterans.
We performed a PubMed and Google Scholar search using the keywords: African-American veteran, prostate cancer, mortality, PSA density, molecular markers, and Agent Orange. The articles that were relevant to the clinical, molecular, social, and health policy aspects of the diagnosis and treatment of prostate cancer in African-American veterans were analyzed. The data was then summarized.
After surveying the literature, we found several areas where the African-American veteran population differed from their Caucasian counterparts. These areas were incidence, clinical course, social differences, PSA levels, mortality rate, and molecular markers. A subset of the veteran population was also exposed to Agent Orange, which has been shown to increase the incidence of aggressive forms of prostate cancer. Lastly, the current USPTF guidelines recommending against prostate cancer screening were based on patient cohorts containing disproportionately low numbers of African-Americans, limiting their extension to the African-American veteran population.
After reviewing and summarizing the literature, we contend that a need exists to develop and implement more targeted prostate cancer screening guidelines for African-American veterans.
前列腺癌是美国男性除皮肤癌以外最常见的癌症，也是癌症死亡的第二大主要原因。2012 年，美国预防服务工作组建议不要基于前列腺特异性抗原进行前列腺癌筛查，无论种族或年龄如何，因为这种筛查会过度治疗低风险疾病，且对疾病结果没有影响。然而，在非裔美国男性中，前列腺癌的发病率几乎高出 60%，死亡率是白人男性的两到三倍。在非裔美国退伍军人亚群中，许多人接触过会增加高危前列腺癌发病率的化学物质。根据量化，每年有 3471.9 名退伍军人患有前列腺癌，每年有 556 名前列腺癌死亡。考虑到这些事实，我们探讨是否应该对非裔美国男性退伍军人进行前列腺癌筛查。此前，我们回顾了一般人群中关于非裔美国人的数据。我们得出的结论是，需要为非裔美国人制定新的筛查指南。在这里，我们回顾了与非裔美国退伍军人相关的前列腺癌的相关问题。
我们使用关键词：非裔美国退伍军人、前列腺癌、死亡率、PSA 密度、分子标志物和橙剂，在 PubMed 和 Google Scholar 上进行了搜索。分析了与非裔美国退伍军人前列腺癌的临床、分子、社会和卫生政策方面相关的文章。然后对数据进行了总结。
在调查文献后，我们发现非裔美国退伍军人人群与白人退伍军人存在几个不同之处。这些方面包括发病率、临床病程、社会差异、PSA 水平、死亡率和分子标志物。退伍军人人群中的一个亚群还接触过橙剂，这已被证明会增加侵袭性前列腺癌的发病率。最后，目前美国预防服务工作组建议反对前列腺癌筛查的指南是基于患者队列，其中非裔美国人的数量不成比例地低，限制了这些指南扩展到非裔美国退伍军人人群。
在回顾和总结文献后，我们认为需要为非裔美国退伍军人制定和实施更有针对性的前列腺癌筛查指南。
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