Self‐Identified African Americans and prostate cancer risk: West African genetic ancestry is associated with prostate cancer diagnosis and with higher Gleason sum on biopsy

• Published in: Cancer medicine (Malden, MA) Vol. 8; no. 16; pp. 6915 - 6922
• Main Authors: Grizzle, William E., Kittles, Rick A., Rais‐Bahrami, Soroush, Shah, Ebony, Adams, George W., DeGuenther, Mark S., Kolettis, Peter N., Nix, Jeffrey W., Bryant, James E., Chinsky, Ravi, Kearns, James E., Dehimer, Kerry, Terrin, Norma, Chang, Hong, Gaston, Sandra M.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.11.2019; John Wiley and Sons Inc; Wiley
• Subjects: Africa, Western - ethnology; African American; African Americans - ethnology; African Americans - genetics; African Continental Ancestry Group - ethnology; African Continental Ancestry Group - genetics; Aged; Anxiety; Biopsy; Clinical Cancer Research; Health care access; Health risk assessment; Humans; Male; Middle Aged; Mortality; Neoplasm Grading; Original Research; Patients; Population; Population genetics; prostate biopsy; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - genetics; Prostatic Neoplasms - pathology; Risk; Studies; Ultrasonic imaging; Variables; West African ancestry; Africa, Western; Northern California; Chicago Illinois; Alabama; United States > US; prostate biopsy; prostate cancer; West African ancestry; African American
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.2434

Concerns about overtreatment of clinically indolent prostate cancer (PrCa) have led to recommendations that men who are diagnosed with low‐risk PrCa be managed by active surveillance (AS) rather than immediate definitive treatment. However the risk of underestimating the aggressiveness of a patient's PrCa can be a significant source of anxiety and a barrier to patient acceptance of AS. The uncertainty is particularly keen for African American (AA) men who are about 1.7 times more likely to be diagnosed with PrCa than European American (EA) men and about 2.4 times more likely to die of this disease. The AA population, as many other populations in the Americas, is genetically heterogeneous with varying degrees of admixture from West Africans (WAs), Europeans, and Native Americans (NAs). Recommendations for PrCa screening and management rarely consider potential differences in risk within the AA population. We compared WA genetic ancestry in AA men undergoing standard prostate biopsy who were diagnosed with no cancer, low‐grade PrCa (Gleason Sum 6), or higher grade PrCa (Gleason Sum 7‐10). We found that WA genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer‐negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7‐10). Incorporating WA ancestry into the guidelines for making decisions about when to obtain a biopsy and whether to choose AS may allow AA men to personalize their approach to PrCa screening and management. African American men are at higher risk for prostate cancer but public health recommendations rarely consider potential differences in risk within the African American population. We found that in self‐identified African Americans, West African genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7‐10). Incorporating West African ancestry into prostate cancer clinical guidelines may allow African American men to personalize their approach to screening and management.