Barriers and facilitators to healthy lifestyle and acceptability of a dietary and physical activity intervention among African Caribbean prostate cancer survivors in the UK: a qualitative study.

OBJECTIVES: Diet and lifestyle may have a role in delaying prostate cancer progression, but little is known about the health behaviours of Black British prostate cancer survivors despite this group having a higher prostate cancer mortality rate than their White counterparts. We explored the barriers and facilitators to dietary and lifestyle changes and the acceptability of a diet and physical activity intervention in African Caribbean prostate cancer survivors. DESIGN: We conducted semistructured in-depth interviews and used thematic analysis to code and group the data. PARTICIPANTS AND SETTING: We recruited 14 African Caribbean prostate cancer survivors via letter or at oncology follow-up appointments using purposive and convenience sampling. RESULTS: A prostate cancer diagnosis did not trigger dietary and lifestyle changes in most men. This lack of change was underpinned by five themes: precancer diet and lifestyle, evidence, coping with prostate cancer, ageing, and autonomy. Men perceived their diet and lifestyle to be healthy and were uncertain about the therapeutic benefits of these factors on prostate cancer recurrence. They considered a lifestyle intervention as unnecessary because their prostate-specific antigen (PSA) level was kept under control by the treatments they had received. They believed dietary and lifestyle changes should be self-initiated and motivated, but were willing to make additional changes if they were perceived to be beneficial to health. Nonetheless, some men cited advice from health professionals and social support in coping with prostate cancer as facilitators to positive dietary and lifestyle changes. A prostate cancer diagnosis and ageing also heightened men's awareness of their health, particularly in regards to their body weight. CONCLUSIONS: A dietary and physical activity intervention framed as helping men to regain fitness and aid post-treatment recovery aimed at men with elevated PSA may be appealing and acceptable to African Caribbean prostate cancer survivors

Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa

<p>Abstract</p> <p>Background</p> <p>African American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade.</p> <p>Results</p> <p>Several published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks.</p> <p>Conclusion</p> <p>The growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.</p

Multiparametric ultrasound versus multiparametric MRI to diagnose prostate cancer (CADMUS): a prospective, multicentre, paired-cohort, confirmatory study

BACKGROUND: Multiparametric MRI of the prostate followed by targeted biopsy is recommended for patients at risk of prostate cancer. However, multiparametric ultrasound is more readily available than multiparametric MRI. Data from paired-cohort validation studies and randomised, controlled trials support the use of multiparametric MRI, whereas the evidence for individual ultrasound methods and multiparametric ultrasound is only derived from case series. We aimed to establish the overall agreement between multiparametric ultrasound and multiparametric MRI to diagnose clinically significant prostate cancer. METHODS: We conducted a prospective, multicentre, paired-cohort, confirmatory study in seven hospitals in the UK. Patients at risk of prostate cancer, aged 18 years or older, with an elevated prostate-specific antigen concentration or abnormal findings on digital rectal examination underwent both multiparametric ultrasound and multiparametric MRI. Multiparametric ultrasound consisted of B-mode, colour Doppler, real-time elastography, and contrast-enhanced ultrasound. Multiparametric MRI included high-resolution T2-weighted images, diffusion-weighted imaging (dedicated high B 1400 s/mm2 or 2000 s/mm2 and apparent diffusion coefficient map), and dynamic contrast-enhanced axial T1-weighted images. Patients with positive findings on multiparametric ultrasound or multiparametric MRI underwent targeted biopsies but were masked to their test results. If both tests yielded positive findings, the order of targeting at biopsy was randomly assigned (1:1) using stratified (according to centre only) block randomisation with randomly varying block sizes. The co-primary endpoints were the proportion of positive lesions on, and agreement between, multiparametric MRI and multiparametric ultrasound in identifying suspicious lesions (Likert score of ≥3), and detection of clinically significant cancer (defined as a Gleason score of ≥4 + 3 in any area or a maximum cancer core length of ≥6 mm of any grade [PROMIS definition 1]) in those patients who underwent a biopsy. Adverse events were defined according to Good Clinical Practice and trial regulatory guidelines. The trial is registered on ISRCTN, 38541912, and ClinicalTrials.gov, NCT02712684, with recruitment and follow-up completed. FINDINGS: Between March 15, 2016, and Nov 7, 2019, 370 eligible patients were enrolled; 306 patients completed both multiparametric ultrasound and multiparametric MRI and 257 underwent a prostate biopsy. Multiparametric ultrasound was positive in 272 (89% [95% CI 85-92]) of 306 patients and multiparametric MRI was positive in 238 patients (78% [73-82]; difference 11·1% [95% CI 5·1-17·1]). Positive test agreement was 73·2% (95% CI 67·9-78·1; κ=0·06 [95% CI -0·56 to 0·17]). Any cancer was detected in 133 (52% [95% CI 45·5-58]) of 257 patients, with 83 (32% [26-38]) of 257 being clinically significant by PROMIS definition 1. Each test alone would result in multiparametric ultrasound detecting PROMIS definition 1 cancer in 66 (26% [95% CI 21-32]) of 257 patients who had biopsies and multiparametric MRI detecting it in 77 (30% [24-36]; difference -4·3% [95% CI -8·3% to -0·3]). Combining both tests detected 83 (32% [95% CI 27-38]) of 257 clinically significant cancers as per PROMIS definition 1; of these 83 cancers, six (7% [95% CI 3-15]) were detected exclusively with multiparametric ultrasound, and 17 (20% [12-31]) were exclusively detected by multiparametric MRI (agreement 91·1% [95% CI 86·9-94·2]; κ=0·78 [95% CI 0·69-0·86]). No serious adverse events were related to trial activity. INTERPRETATION: Multiparametric ultrasound detected 4·3% fewer clinically significant prostate cancers than multiparametric MRI, but it would lead to 11·1% more patients being referred for a biopsy. Multiparametric ultrasound could be an alternative to multiparametric MRI as a first test for patients at risk of prostate cancer, particularly if multiparametric MRI cannot be carried out. Both imaging tests missed clinically significant cancers detected by the other, so the use of both would increase the detection of clinically significant prostate cancers compared with using each test alone. FUNDING: The Jon Moulton Charity Trust, Prostate Cancer UK, and UCLH Charity and Barts Charity

Can targeting women with behavioural science 'nudges' help black men to find out more about their high risk of contracting prostate cancer?

Prostate cancer is now deadlier than breast cancer in the UK, with more than 12,000 men dying from it in the country in 2018. Black men are nearly three times more likely to suffer prostate cancer, with one in four contracting the disease in their lifetime. Despite being a high risk group very few black men aged 45 and over visit their GP to discuss the pros and cons of screening. This is a problem as early onset of the disease presents no symptoms and when symptoms do appear, such as urinary problems, and men do visit a doctor it is often too late to reverse the cancer's spread. This study investigates using the strong social norm of wives and girlfriends being the guardian of black men's health as a way of influencing their behaviour. Using a historically controlled study via email we tested the social norm nudge in the field with 13 Afro-Caribbean organisations across the UK. The trial found the social norm nudge produced a 15.5 per cent click-through rate, which was significantly higher than the historical controls. Meanwhile, the messenger effect saw a click-through rate of 38.5 per cent on men. At a national level the social norm nudge would equate to 37,315 black women taking positive action to find out more information about their husband or boyfriend's high risk of contracting prostate cancer. Use clinicians as messengers in correspondence to promote engagement with information about prostate cancer screening

Quality of Evidence on Prostate Cancer in Nigeria

Prostate cancer is the 2ndcommonest malignancy in men worldwide. It is, however, the commonest in Nigeria. While several disparities have been documented between Caucasian men and men of African descent, there is limited research on prostate cancer in Nigeria. Evidence-based medicine is a key tool in making clinical decisions and developing screening and treatment guidelines. This review was undertaken to assess the levels of evidence on prostate cancer research in Nigeria. A systematic review of all research published on prostate cancer from January 1975 to May 2018 in Nigeria was conducted. We reviewed all articles found on various databases by searching for “Prostate cancer in Nigeria”. We classified them based on their study designs into different levels of evidence as well as the year of publication. Meta-analyses were not considered in the review.&nbsp; A total of 171 articles were eligible for this review. Most publications were at the 4th(66%) and 5thlevels of evidence (17%) respectively. No clinical trials on prostate cancer in Nigeria was seen or registered on clinicaltrials.gov, hence no studies at level 1 (a, b or c) of evidence published in Nigeria. The commonest type of study design was cross-sectional studies accounting for 56% of all publications.Prostate cancer research is currently at low levels of evidence in Nigeria. It is pertinent to explore and increase funding channels for cancer-related research

Standardized Global Behavioral and Epidemiological Measures for Prostate Cancer Studies in Black Men

Multicenter trans-national studies may be required to understand the complex causes of and solutions to prostate cancer disparities in Black men. In 2014, two cancer epidemiology consortia supported by the US National Cancer Institute (NCI) - the Prostate Cancer Transatlantic Consortium (CaPTC), and African-Caribbean Cancer Consortium (AC3) - formed a consortia alliance to address the disproportionate burden of prostate cancer in Black men. As part of the alliance, this global study focused on developing standardized and culturally tailored data elements and measures for prostate cancer research in these populations.&nbsp; The study objective was achieved by a Consensus Working Group using the NCI–Grid-Enable Measures (GEM) platform. The Consensus Working Group members were assigned to three Special Interest Groups to focus on behavioral, epidemiology and clinical topics. Based on crowd-sourcing methodology, the initial standardization decisions were made by each group using GEM. This was followed using nominal group technique to build consensus. Finally, a one-day consensus development conference was held to facilitate the input of the scientific community. The use of the GEM platform, nominal group technique and a consensus development conference resulted in agreement among stakeholders for a recommended set of measures that included 25 behavioral scales and 24 epidemiological scales. The measures developed in this process will facilitate data harmonization and data sharing for multiethnic studies of Black men globally and these measures can be used by other researchers in this are

The risk of prostate cancer amongst Black men in the United Kingdom: The PROCESS cohort study

Objectives: It is known that African American men have a greater risk of prostate cancer than white men. We investigated whether this was true for first-generation black Caribbean and black African men in the United Kingdom. Methods: A clinical cohort study design recruiting all cases of prostate cancer diagnosed over a 5-yr period and residing in defined areas of London and Bristol. We calculated the age-standardised incidence rates and relative risk for all black men, and black Caribbean and black African men versus white men. Results: Black men had higher age-adjusted rates of prostate cancer (166 per 100,000, 95% confidence interval [95%CI], 151-180 per 100,000) than white men (56.4 per 100,000, 95%CI, 53.3-59.5 per 100,000). The relative risks for all black, black Caribbean, and black African men were 3.09 (95%CI, 2.79-3.43; p < 0.0001), 3.19 (95%CI, 2.85-3.56; p < 0.0001) and 2.87 (95%CI, 2.34-3.53; p < 0.0001), respectively. There was no strong evidence that the rates for black Caribbean differed from black African men. The higher risk in black men compared with white men was more apparent in younger age groups (p value for interaction <0.001). Conclusions: Black men in the United Kingdom have substantially greater risk of developing prostate cancer compared with white men, although this risk is lower than that of black men in the United States. The similar rates in black Caribbean and black African men suggest a common genetic aetiology, although migration may be associated with an increased risk attributable to a gene-environment interaction.7 page(s