Epidemiologi
cal data from the United States of Ameri
ca (USA) indi
cate that the in
ciden
ce and mortality of prostate
can
cer is higher among Bla
ck Afri
can-Ameri
can men (AAM) than among White (Cau
casian) Ameri
can men (CAM). Earlier studies suggesting that prostate
can
cer is relatively rare among indigenous Bla
ck men in Afri
ca are probably flawed by underreporting be
cause re
cent studies indi
cate that the in
ciden
ce rates among Bla
ck men are similar to those of White men living in Afri
ca. The higher in
ciden
ce of prostate
can
cer among AAM has been as
cribed to ra
cial differen
ces in geneti
c sus
ceptibility, dietary fa
ctors, or androgen metabolism. However, it may also be due to registration artefa
cts be
cause in Afri
ca the reported in
ciden
ce rates of prostate
can
cer in different
countries
correlate dire
ctly with the per
capita gross national produ
ct, suggesting improved a
ccess to medi
cal fa
cilities is responsible for higher reported in
ciden
ce rates.
The greater prostate cancer mortality among AAM may result from higher tumour grade and stage and higher serum PSA at presentation, but it has also been suggested that prostate cancer is biologically more aggressive in AAM than in CAM. However, recent studies indicate that tumour grade and stage and serum PSA at presentation are similar in the races, with no difference in survival after multivariate analysis controlling for pretreatment cancer severity. This suggests that the higher prostate cancer mortality among AAM results from socio-economic factors and limited access to healthcare. Black men living inside as well as outside of Africa still tend to present with locally advanced or metastatic prostate cancer due to lack of early detection programmes.