AUA 2017: Lower Risk of Prostate Cancer in Asian Men – from Less Screening or True Racial Differences?

Boston, MA ( Prostate cancer (PC) incidence and diagnosis rates are lower in Asian men than in Caucasian men. Recent published literature cites either less aggressive screening practices (i.e. a decreased opportunity to diagnose prostate cancer) or inherent hereditary or cultural differences. Dr. Tom Feng from Los Angeles, CA attempts to elucidate a causal relationship between Asian ethnicity and PC diagnosis rates via cohort analysis of the REDUCE trial.

The REDUCE trial was a 4-year, multi-institutional, randomized, double-blinded, and placebo controlled study that followed biopsy-negative men with protocol-dictated PSA screening and PSA-independent biopsies at 2- and 4- years. By utilizing this study design as a backdrop to analyze the interactions between the Asian ethnicity and prostate cancer diagnosis, Dr. Feng is able to control for PSA screening rate differences between both groups. A multivariate logistic regression additionally assessed the association between race and receipt of prostate biopsy.

7,296 patients in the REDUCE trial were included. Baseline age, PSA, family history of prostate cancer, and digital rectal exam findings were comparable to Caucasian men, with Asian men having lower median BMI (24.8 vs. 26.9, p<0.001) and lower prostate weight (34.2 vs. 43.4 cc, p<0.001). After adjusting for clinicopathological characteristics, Asian men were diagnosed with PC at a significantly lower rate, less aggressive, low-grade during the period of 4-year study as compared to Caucasian men.

Recent developments in the USPSTF grade D recommendation may site decreased rates of screening as reason for lower rates of diagnosis. However, Dr. Feng and colleagues data suggests that less screening does not completely explain the lower risk of prostate cancer among Asian men. Additional population-based studies with systematic screening and biopsy practices are required to further elucidate the relationship between race and PC diagnosis.

Presented By: Tom Feng

Author(s): Tom Feng, Alexis Freedland, Lauren Howard, Adriana Vidal, Daniel Moreira, Ramiro Castro-Santamaria, Gerald Andriole, Stephen Freeland

Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA