The definition of blacks or African Americans as a race in the United States is unclear. There is no genetic definition of any race at this time. Phenotypic heterogeneity is characteristic of the United States population of African Americans. However, there are cultural factors that may define African Americans as an ethnic group or race in relation to health. Recent data demonstrate a strong association between prostate cancer progression and a high-fat diet.1 Whittemore recently reported that among groups of men who consume high amounts of saturated fats, African Americans consumed the most, compared to Caucasians, Chinese Americans, and Japanese Americans.2 Evidence indicating a greater percentage of bioactive lipids in the biologic system of African Americans suggests a diet high in fat content, or greater expression of enzymes converting free fatty acids to bioactive lipids.3 Thus, diet as an epige-netic factor in prostate cancer (PCa) may distinguish African Americans from other populations.
Mortality from prostate cancer is two to three times higher among African American men between the ages of 40 to 70 years than among Caucasian men in the same age group.4 The reason for this disproportionate high mortality rate among African American prostate cancer patients compared to Caucasians is unknown, but many studies have demonstrated that African American men present with more advanced tumors.5-8 The important question is whether this presentation of advanced prostate cancer is secondary to health-seeking behaviors, access to care, and biologic factors, or a combination of these or other factors.
This chapter will discuss African American men as an ethnic or racial group in comparison to Caucasian men. It will also review epidemiologic and histologic features of prostate cancer in these two distinct populations, as well as clinical and biologic factors.
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