African-American men are known to have a greater risk of developing prostate cancer. But is the cancer more aggressive in African-American men compared to white men? Many experts think so.

However, according to two recent reports, that may not be the case.

When detected early and monitored closely if the cancer recurs, prostate cancer may not differ for men of different ethnic backgrounds. The real disparity may be in lack of screening and delayed treatment in African-American men.

The first study examined whether African-American men had a worse prognosis for prostate cancer after recurrence than white men, as reported in the Journal of Urology (Vol. 166: 1328-1332) by Eric A. Bissonette, MS, from the University of Virginia Health Sciences Center in Charlottesville, and colleagues.

The researchers reviewed the medical records of 955 men treated with surgery for localized disease. From this group, 127 white and 37 African-American men who developed evidence of cancer recurrence were studied further.

The researchers then determined for each man the prostate-specific antigen (PSA) velocity, a measurement for how quickly the protein increases — the higher the velocity, the more rapid the increase in prostate cancer. PSA is a protein produced by the prostate gland; levels of PSA usually rise in men with prostate cancer.

PSA is followed in prostate cancer patients to monitor response to treatment and cancer growth once it recurs.

When analyzed for the effects of race, the researchers found no difference between African-American men and white men for PSA velocity when the prostate cancer recurred. According to the authors, looking at PSA velocities can be used as a substitute measure for tumor aggressiveness.

They conclude, "These results suggest that the reason for the higher incidence and mortality of African-American patients may not be due to tumor growth rate, but other biological or behavioral features that remain to be determined fully."

What could those features be? African-American men have more advanced disease when they are first diagnosed with prostate cancer. Could delay in diagnosis be the cause or is the cancer more aggressive in these men?

What would happen if African-American men took advantage of screening for prostate cancer at the same rate as white men, and received the same medical treatment?

By looking at medical care provided in military health facilities that provide equal access, researchers were able to determine the trends in prostate cancer management in 797 consecutive patients from 1988 through 1999, as reported in Cancer (Vol. 92, No. 10: 2673-2679).

Of the patients studied, 195 men were African-American and 587 were white. Over time, Edmond L. Paquette, MD, from the Center for Prostate Disease Research, Rockville, Md., and colleagues, discovered there were remarkable improvements in the findings for African-American men when they were first diagnosed and treated for their prostate cancer.

Spread of the tumor decreased from 100% of the men to 34.8%. The tumors were completely removed in about three-fourths of the men at the end of the study period, compared to 100% of the African-American men having some microscopic evidence of tumor left behind.

PSA levels at the time of diagnosis also decreased dramatically for African-American men over the 10 years of the study, which meant the cancers were found much earlier. In fact, in the final year of the study, the PSA levels at diagnosis for African-American men and white men were almost identical. This was not the case at the beginning of the study.

Why haven't all African-American men, regardless of where they receive their care, had the same benefits over time?

The authors comment, "The difference in access to care, at least in the nonmilitary population, and education are probably the most predominant factors contributing to the discrepancy in clinical outcomes between the races."

They go on to point out that African Americans must realize that prostate cancer is curable if found early, and that they have increased risk for the disease. The authors also note their data supports the American Cancer Society recommendation that African-American men begin PSA testing at age 45.

In conclusion, the authors report that their data "suggest that the predominant reason that African-American men had historically worse outcomes is because of inadequate screening and lack of equal treatment."

However, they also caution that further follow-up is necessary to be certain that the earlier diagnosis noted in this study translates into better survival.