Argument for prostate cancer screening in populations of African-Caribbean origin

Black men's experiences of support following treatment for prostate cancer in England: A qualitative study

PURPOSE

Prostate cancer is a leading cause of death in black men in the United Kingdom (UK). Evidence suggests that unmet supportive care needs are prevalent in contemporary healthcare, particularly for men with advanced prostate cancer, whilst less has been written specifically about the supportive care needs of black men. Therefore this study will examine black men's experiences of support following prostate cancer treatment in England.

METHOD

A qualitative research design was employed. Twenty black African and black Caribbean men were interviewed on a face-to-face basis to obtain insightful information about their experiences of prostate cancer. Interviews were recorded and transcribed. Data were analysed using thematic analysis which allowed for emergent themes.

RESULTS

In this study there were six emergent themes. These were: dealing with the treatment effect, support from loved ones, individuals and organisations, healthcare support, spirituality, and positivity. Black men used different coping strategies to deal with the side effects of treatment.

CONCLUSION

Black men experienced a range of supportive care needs. Some men felt that their individual needs as black men were not met by healthcare professionals, although no specific reasons were forthcoming as to why they felt this way. Healthcare professionals should be aware of the support mechanisms that black men have used throughout the prostate cancer journey and to consider these approaches when treating and caring for black men.

Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care

CONTEXT

Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes.

OBJECTIVE

To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions.

EVIDENCE ACQUISITION

A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes.

EVIDENCE SYNTHESIS

Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men.

CONCLUSIONS

Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes.

PATIENT SUMMARY

Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.

Prostate cancer: understanding patients' treatment options

Prostate cancer is the most common cancer among men in the UK. It is a disease with no specific preventable risk factors, no specific signs and symptoms, and a significant health burden. This article explains the various treatment options available for patients with prostate cancer, with the aim of assisting nurses in supporting person-centred decision-making. It also discusses the risk factors, signs and symptoms, diagnosis, staging, grading and risk stratification of prostate cancer.

Serum carotenoid and retinol levels in African-Caribbean Tobagonian men with high prostate cancer risk in comparison with African-American men

Black men are known to have a higher risk for prostate cancer (PC). Carotenoids and retinol, linked to PC, have not been compared in different black populations at risk. We examined serum carotenoid and retinol levels between PC-free African-Caribbean (AC) Tobagonian men with a high PC risk (high-grade prostatic intraepithelial neoplasia, atypical foci or repeated abnormal PC screenings) and African-American (AA) men with elevated serum prostate-specific antigen (PSA) levels (≥4 ng/ml). AC men who participated in the 2003 lycopene clinical trial and AA men who participated in the 2001-2006 National Health and Nutrition Examination Survey were compared. Serum specimens were analysed for carotenoid (β-carotene, α-carotene, β-cryptoxanthin, lutein/zeaxanthin and lycopene) and retinol levels by isocratic HPLC. Quantile regression was used to examine the association between serum carotenoid and retinol levels and black ethnicity, overall and among men with elevated serum PSA. There were sixty-nine AC men and sixty-five AA men, aged 41-79 years, included. AC men were associated with lower serum lycopene and retinol levels, and higher serum α- and β-carotenes and lutein/zeaxanthin levels compared with AA men, after adjusting for age, BMI, ever smoked cigarettes, education and hypertension (P≤0·03). Among men with elevated PSA, serum retinol was no longer statistically significant with ethnicity (P=0·06). Possible differences may be attributed to dietary intake, genetics and/or factors that influence bioavailability of these micronutrients. Prospective studies are warranted that investigate whether these differences in micronutrients between AC Tobagonian and AA men influence PC risk.

What's new in screening in 2015?

PURPOSE OF REVIEW

The aim of this review was to highlight important articles in the field of prostate cancer screening published during 2015 and early 2016. Four major areas were identified for the purpose: screening strategies, post-United States Preventive Services Task Force (USPSTF) 2011-2012, screening trends/patterns, and shared decision making.

RECENT FINDINGS

Several studies furthered the evidence that screening reduces the risk of metastasis and death from prostate cancer. Multiplex screening strategies are of proven benefit; genetics and MRI need further evaluation. Prostate-specific antigen (PSA) screening rates declined in men above age of 50 years, as did the overall prostate cancer incidence following the USPSTF 2011-2012 recommendation against PSA. The consequences of declining screening rates will become apparent in the next few years. More research is needed to identify the most optimal approach to engage in, and implement, an effective shared decision-making in clinical practice.

SUMMARY

Data emerging in 2015 provided evidence on the question of how best to screen and brought more steps in the right direction of 'next-generation prostate cancer screening'. Screening is an ongoing process in all men regardless of whether or not they might benefit from early detection and treatment. After the USPSTF 2011-2012 recommendation, the rates of PSA testing are declining; however, this decline is observed in all men and not solely in those who will not benefit from the screening. The long-term effect of this recommendation might not be as anticipated. More studies are needed on how to implement the best available evidence on who, and when, to screen in clinical practice.

What Prevents Men Aged 40-64 Years from Prostate Cancer Screening in Namibia?

Objectives. Although a growing body of evidence demonstrates the public health burden of prostate cancer in SSA, relatively little is known about the underlying factors surrounding the low levels of testing for the disease in the context of this region. Using Namibia Demographic Health Survey dataset (NDHS, 2013), we examined the factors that influence men's decision to screen for prostate cancer in Namibia. Methods. We use complementary log-log regression models to explore the determinants of screening for prostate cancer. We also corrected for the effect of unobserved heterogeneity that may affect screening behaviours at the cluster level. Results. The results show that health insurance coverage (OR = 2.95, p = 0.01) is an important predictor of screening for prostate cancer in Namibia. In addition, higher education and discussing reproductive issues with a health worker (OR = 2.02, p = 0.05) were more likely to screening for prostate cancer. Conclusions. A universal health insurance scheme may be necessary to increase uptake of prostate cancer screening. However it needs to be acknowledged that expanded screening can have negative consequences and any allocation of scarce resources towards screening must be guided by evidence obtained from the local context about the costs and benefits of screening.

Meeting the unmet support needs of BME men with prostate cancer

Men with prostate cancer from black and minority ethnic (BME) communities have reported many unmet information and support needs. A literature review identified the many challenges health professionals face in addressing these unmet needs, and suggested that not enough is known about the psychosocial effects of a prostate cancer diagnosis on men from BME communities in the UK. Affected men may have little or no awareness or knowledge of prostate cancer, receive inadequate information and fear the disease. Nurses can address these issues through improving patients' knowledge and awareness of prostate cancer, providing high-quality information to patients and their families, alleviating fear and promoting survivorship among this minority group; they can also facilitate staff training. Health professionals should look beyond the physical effects and consider the psychosocial effects of such a diagnosis when assessing the needs of these men. Practitioners need to overcome the various challenges to meeting these needs to provide more effective care to men from BME groups.