This chapter clearly demonstrates that African American men have a worse outcome from prostate cancer than do Caucasian men. The multiple factors described in the chapter probably account for this difference. The initial event distinguishing African Americans from Caucasians is high-grade PIN, which may account for an earlier malignant transformation to clinically significant PCa. If hormonal levels and activity are influenced by a high-fat diet as suggested by Ross and Henderson,54 then the pathway of high-fat content-high level of hormonal activity-high-grade PIN may be significantly responsible for the increased clinically significant PCa among African Americans compared to Caucasians at a younger age. High-fat diet or bioactive lipids may also have an independent role in increasing invasiveness and metastases, as is suggested by Gao et al.3 It may be assumed that men who consume a high-fat diet may take in less fiber containing lycopene which may be protective against prostate cancer. Giovan-nucci et al. have demonstrated the low intake of lycopene by African American men and a high incidence of PCa.55 The higher prevalence of HPC1 among African Americans versus Caucasians has not been confirmed yet, but this factor may also contribute to the diagnosis of clinically significant PCa at a younger age. These are some of the multiple factors that may contribute to a worse outcome from prostate cancer among African Americans compared to Caucasians.
Among African American men over the age of 65 or 70 years, we may be observing a less aggressive form of prostate cancer, similar or less aggressive than PCa among Caucasian men. This schema may serve as a model describing the factors influencing prostate cancer among African American versus Caucasian men (Figure 2-1). Further research is required to understand the biology and molecular epidemiology of prostate cancer among African Americans.
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