Is prostate cancer more common and more aggressive in African men?

The highest prostate cancer incidence and mortality rates in the world have been reported among Black African-American men [AAM] living in the United States of America. These rates are significantly higher for AAM compared to White [Caucasian] American men [CAM]. However, prostate cancer is not the only malignancy which is more common in AAM compared to White American men or women. Although prostate cancer has the highest Black / White mortality ratio, it is not the only malignancy which has a higher mortality in AAM compared to CAM. Numerous reports have shown that AAM present with higher grade and stage tumors, higher serum PSA levels, and that they are less likely to receive definitive or curative treatment and have a worse prognosis compared with CAM. It has been suggested that prostate cancer is not only more common, but also more biologically aggressive in AAM compared with CAM. Hypotheses attempting to explain this include genetic differences, dietary factors, higher testosterone levels or increased androgen receptor activity. However, the majority of reports from the USA indicate that, when controlled for major prognostic factors, the outcome for clinically localized as well as advanced prostate cancer does not depend on race. Several studies have indicated that socio- economic factors, decreased awareness of prostate cancer and limited access or decreased utilization of health care contribute to the poorer outcomes in AAM. Earlier studies have suggested that prostate cancer is relatively rare among indigenous Black men living in Africa. However, cancer incidence data in Africa are likely to underestimate the true rates because of underdiagnosis and underreporting. The frequency distribution of cancers in African countries, as well as more recent data indicate that prostate cancer is not rare among Black men living in Africa and that the incidence is probably similar to that of White men, although not as high as that reported for Black men living outside Africa. It is well documented that African men with prostate cancer present with more advanced disease and that palliative rather than curative treatment is used in the majority of patients. There are no reliable age-adjusted prostate cancer mortality rates available for African countries. However, there is as yet no evidence that prostate cancer in Black men living inside Africa is biologically more aggressive than in other populations