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Finally, good news about prostate carcinoma in African American men

In this issue, Myers et al. provide evidence that strategic interventions can have a positive impact on our ability to reduce the disproportionate burden of prostate cancer among African American men. It is well known that African American men tend to present with more advanced disease and, probably as a result of this, have a markedly lower survival rate than others in the general population. The study reported by Myers et al. contains good news. This landmark study suggests that if the appropriate resources are provided, African American men can be selectively and successfully encouraged to adhere to prostate cancer screening and follow-up. Although there is ongoing controversy about the value of screening for prostate cancer, it continues to be done widely. Recent studies demonstrate that the rate of mortality due to prostate cancer has declined recently. This probably reflects the first evidence of the beneficial impact of screening and early treatment. In addition to this study, the recent report by Labrie et al. from Quebec, Canada, suggest that it is possible for screening to result in a substantial reduction in prostate cancer specific mortality. The point is, if anybody should be screened, African American men should be, and there is evidence that screening may reduce mortality. Screening certainly results in patients’ being diagnosed at an earlier stage, which should make them “more curable.” Prospective randomized trials have demonstrated that once patients decide to have treatment, the treatment may have a significant impact on survival. For example, a study conducted by the Medical Research Council (MRC) of the United Kingdom showed that early hormone therapy resulted in a reduction in mortality due to prostate cancer and overall mortality compared with no initial treatment, but only in patients who had nonmetastatic prostate cancer. An additional study by Bolla et al. showed that if patients with advanced disease were given hormone therapy plus radiation, they had better survival than patients given radiation therapy alone. Both of these studies made the point that people can no longer argue that “no treatment has been shown to prolong survival from prostate cancer,” but in fact early intervention for men with a significant tumor burden does result in prolonged survival. An additional point is that those patients who have undergone treatment have had a good quality of life when formal quality of life studies have been conducted. 1