Articles

Ethnic Paradigm in Prostate Cancer – does it really matter?

BJMO - 2019, issue 2, february 2019

Fadi Dalati

Background

Prostate Cancer (PCa) is a major mortality cause with higher incidence in western countries and African population, and lower in Arab countries. Belgium’s population present different origins with 24.2% being immigrants and 46% descendants from outside European Union. The equal-open-access healthcare in Belgium provides an opportunity to study variations in PCa presentation among different ethnicities (Caucasians, Africans and Arabs).

Methods

We retrospectively reviewed 495 consecutive patients medical records (328 Caucasians, 78 Africans and 89 Arabs) who underwent Trans-Rectal-UltraSound(TRUS)-guided prostate biopsy in our institution between January 2013 and March 2017. The parameters analyzed were: age, ethnicity, PSA, digital rectal exam(DRE), Prostate Volume, Gleason score, number of prostate biopsy cores, percentage of cores invaded by cancer and TNM classification.

Results

In our cohort, Africans presented PCa diagnosis at younger age (6 years less) compared to Caucasians and Arabs (p<0.001). Arabs have less PCa diagnosis (p<0.024). After multiple logistic regression Arabs present 45.3% less PCa diagnosis compared to Caucasians (OR 2.21,95%Confidence lntervals[CI] 1.32-3.72, p<0.003) and 39.7% less than Africans (OR 2.52,95%CI 1.25-5.07, p<0.01), even though its predominantly Gleason>7 and Gleason>7(4+3) (OR 2.83,95%CI 1.23-6.5, p<0.014 and OR 2.44,95%CI 1.03-5.76, p<0.043, respectively) and High Risk(HR) (OR 2.37,95%CI 1.07-5.25, p<0.033) when compared to Caucasians. Africans also present more Gleason>7(4+3) (OR 5.49,95%CI 2.25-13.36, p<0.001) and PCa≥HR (OR 4.59,95%CI 1.93- 10.9, p<0.001) compared to Caucasians.

Conclusions

In an equal-open-access healthcare system, although Arabs have less PCa prevalence, they usually present a predominantly Gleason≥7(4+3) and HR compared to Caucasians, with PCa features more similar to Africans. This may implicate limitations for treatment options as active surveillance.

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