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Prostate cancer metastasis and health disparities: a systematic review

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

Prostate cancer (PCa), one of the most prevalent malignancies affecting men, significantly contributes to increased mortality rates worldwide. While the causative death is due to advanced metastatic disease, this occurrence disproportionately impacts men of African descent compared to men of European descent. In this review, we describe potential mechanisms underlying PCa metastases disparities and current treatments for metastatic disease among these populations, differences in treatment outcomes, and survival rates, in hopes of highlighting a need to address disparities in PCa metastases.

Methods

We reviewed existing literature using databases such as PubMed, Google Scholar, and Science Direct using the following keywords: “prostate cancer metastases”, “metastatic prostate cancer disparity”, “metastatic prostate cancer diagnosis and treatment”, “prostate cancer genetic differences and mechanisms”, “genetic differences and prostate tumor microenvironment”, and “men of African descent and access to clinical treatments”. The inclusion criteria for literature usage were original research articles and review articles.

Results

Studies indicate unique genetic signatures and molecular mechanisms such as Epithelial-Mesenchymal Transition (EMT), inflammation, and growth hormone signaling involved in metastatic PCa disparities. Clinical studies also demonstrate differences in treatment outcomes that are race-specific, for example, patients of African descent have a better response to enzalutamide and immunotherapy yet have less access to these drugs as compared to patients of European descent.

Conclusions

Growing evidence suggests a connection between a patient’s genetic profile, the prostate tumor microenvironment, and social determinants of health that contribute to the aggressiveness of metastatic disease and treatment outcomes. With several potential pathways highlighted, the limitations in current diagnostic and therapeutic applications that target disparity in PCa metastases warrant rigorous research attention.

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Fig. 1: Prostate cancer and bone tumor microenvironment (TME).
Fig. 2: Role of second-generation androgens in androgen-dependent signaling through the androgen receptor.
Fig. 3: Prostate cancer patient treatment outcomes according to ancestry.

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Data availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Acknowledgements

We thank the National Institutes of Health, National Institutes of Minority Health and Health Disparities (NIMHD): NIMHD U54MD013376, for their support of this research.

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Authors and Affiliations

  1. Department of Biology, Morgan State University, Baltimore, MD, 21251, USA

    Yusuf Liadi, Taaliah Campbell, Precious Dike, Maxine Harlemon & Valerie Odero-Marah

  2. Center for Cancer Research and Therapeutic Development, Department of Biological Sciences, Clark Atlanta University, Atlanta, GA, 30314, USA

    Taaliah Campbell & Maxine Harlemon

  3. Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, 21251, USA

    Bethtrice Elliott & Valerie Odero-Marah

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Contributions

Concept of the manuscript: VO-M. Literature Review: YL, TC, PD, MH, BE. Drafting of the manuscript: YL, TC, PD, MH, BE. Editing review article: BE, VO-M, YL, TC, PD, MH. Visualization: TC. Supervision: VO-M.

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Correspondence to Valerie Odero-Marah.

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Liadi, Y., Campbell, T., Dike, P. et al. Prostate cancer metastasis and health disparities: a systematic review. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00667-1

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