Department of Biology, Morgan State University, Baltimore, MD, 21251, USA.
Center for Cancer Research and Therapeutic Development, Department of Biological Sciences, Clark Atlanta University, Atlanta, GA, 30314, USA.
Prostate Cancer Prostatic Dis. 2024 Jun;27(2):183-191. doi: 10.1038/s41391-023-00667-1. Epub 2023 Apr 12.
Prostate cancer (PCa), one of the most prevalent malignancies affecting men, significantly contributes to increased mortality rates worldwide. While the causative death is due to advanced metastatic disease, this occurrence disproportionately impacts men of African descent compared to men of European descent. In this review, we describe potential mechanisms underlying PCa metastases disparities and current treatments for metastatic disease among these populations, differences in treatment outcomes, and survival rates, in hopes of highlighting a need to address disparities in PCa metastases.
We reviewed existing literature using databases such as PubMed, Google Scholar, and Science Direct using the following keywords: "prostate cancer metastases", "metastatic prostate cancer disparity", "metastatic prostate cancer diagnosis and treatment", "prostate cancer genetic differences and mechanisms", "genetic differences and prostate tumor microenvironment", and "men of African descent and access to clinical treatments". The inclusion criteria for literature usage were original research articles and review articles.
Studies indicate unique genetic signatures and molecular mechanisms such as Epithelial-Mesenchymal Transition (EMT), inflammation, and growth hormone signaling involved in metastatic PCa disparities. Clinical studies also demonstrate differences in treatment outcomes that are race-specific, for example, patients of African descent have a better response to enzalutamide and immunotherapy yet have less access to these drugs as compared to patients of European descent.
Growing evidence suggests a connection between a patient's genetic profile, the prostate tumor microenvironment, and social determinants of health that contribute to the aggressiveness of metastatic disease and treatment outcomes. With several potential pathways highlighted, the limitations in current diagnostic and therapeutic applications that target disparity in PCa metastases warrant rigorous research attention.
前列腺癌（PCa）是男性最常见的恶性肿瘤之一，在全球范围内导致死亡率上升。虽然导致死亡的原因是晚期转移性疾病，但与欧洲裔男性相比，这种情况在非洲裔男性中更为普遍。在这篇综述中，我们描述了 PCa 转移差异的潜在机制以及这些人群中转移性疾病的当前治疗方法、治疗结果和生存率的差异，希望强调需要解决 PCa 转移中的差异。
我们使用 PubMed、Google Scholar 和 Science Direct 等数据库，使用以下关键词来回顾现有文献：“前列腺癌转移”、“转移性前列腺癌差异”、“转移性前列腺癌诊断和治疗”、“前列腺癌遗传差异和机制”、“遗传差异和前列腺肿瘤微环境”以及“非洲裔男性和获得临床治疗”。文献使用的纳入标准是原始研究文章和综述文章。
研究表明，转移性 PCa 差异涉及独特的遗传特征和分子机制，如上皮-间质转化（EMT）、炎症和生长激素信号。临床研究还表明，治疗结果存在种族特异性差异，例如，与欧洲裔男性相比，非洲裔男性对恩扎卢胺和免疫疗法的反应更好，但获得这些药物的机会较少。
越来越多的证据表明，患者的遗传特征、前列腺肿瘤微环境和健康的社会决定因素之间存在联系，这些因素导致转移性疾病的侵袭性和治疗结果的差异。鉴于已经强调了几个潜在的途径，目前针对 PCa 转移差异的诊断和治疗应用的局限性需要严格的研究关注。
