Cobbs Charles, Chesnut Gregory T, Shafi Ayesha A
Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Urology Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Cancer Med. 2025 Jun;14(11):e70979. doi: 10.1002/cam4.70979.
Prostate cancer (PCa) remains a significant public health challenge in the United States, disproportionately affecting African American (AA) men, who face higher incidence rates, more aggressive disease, and elevated mortality compared to Caucasian American (CA) men. This review explores the multifactorial underpinnings of these disparities, integrating genomic, socioeconomic, environmental, and systemic contributors. Genomic analyses reveal that AA men harbor distinct molecular alterations, including higher frequencies of FOXA1, BRAF, and CHD1 mutations, as well as DNA damage repair defects, highlighting the critical need for population-specific precision medicine. Immune-oncologic pathways and stromal interactions within the tumor microenvironment further underscore biological differences driving aggressive disease phenotypes. Concurrently, adverse social determinants-including limited access to care, lower PSA screening rates, delayed treatment, medical mistrust, and underrepresentation in clinical trials-contribute to poorer outcomes. Despite these challenges, evidence from equal-access healthcare systems indicates that when provided equitable treatment, AA men can achieve outcomes comparable to or better than their CA counterparts. This review emphasizes actionable strategies to reduce disparities, including increasing AA representation in clinical trials, enhancing culturally competent patient-provider communication, improving access to early detection and high-quality care, and expanding community-based outreach initiatives. A holistic, interdisciplinary approach is essential to dismantle systemic barriers and achieve health equity in prostate cancer outcomes.
前列腺癌（PCa）在美国仍然是一个重大的公共卫生挑战，对非裔美国（AA）男性的影响尤为严重，与美国白人（CA）男性相比，他们面临着更高的发病率、更具侵袭性的疾病和更高的死亡率。这篇综述探讨了这些差异的多因素基础，整合了基因组、社会经济、环境和全身因素。基因组分析表明，AA男性存在独特的分子改变，包括FOXA1、BRAF和CHD1突变的频率更高，以及DNA损伤修复缺陷，凸显了针对特定人群的精准医学的迫切需求。肿瘤微环境中的免疫肿瘤学途径和基质相互作用进一步强调了驱动侵袭性疾病表型的生物学差异。同时，不良的社会决定因素——包括获得医疗服务的机会有限、PSA筛查率较低、治疗延迟、对医疗的不信任以及在临床试验中的代表性不足——导致了更差的结果。尽管存在这些挑战，但来自平等获得医疗保健系统的证据表明，当给予平等治疗时，AA男性可以取得与CA男性相当或更好的结果。这篇综述强调了减少差异的可行策略，包括增加AA男性在临床试验中的代表性、加强具有文化胜任力的医患沟通、改善早期检测和高质量医疗服务的可及性，以及扩大基于社区的外展举措。采取整体、跨学科的方法对于消除系统性障碍并在前列腺癌治疗结果上实现健康公平至关重要。
