Prostate Cancer Disparity Research
Edward Schaeffer, MD, PhD discusses his prostate cancer disparity research. He explains why African American men with prostate cancer are twice as likely to die than Caucasian men and how his research can impact patients, physicians and improve the medical community’s understanding of prostate cancer.
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Learn more about Edward Schaeffer, MD., PhD
Edward Schaeffer, MD, PhD
Edward Schaeffer, MD, PhD is Chair of the Department of Urology at Feinberg School of Medicine and Program Director of the Genitourinary Oncology Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. His clinical and research focus is the diagnosis and treatment of men with prostate cancer.Learn more about Edward Schaeffer, MD., PhD
Transcription:
Prostate Cancer Disparity Research
Melanie Cole (Host): Welcome, today we’re talking about the latest research in prostate cancer disparities. My guest is Dr. Edward Schaeffer. He is the chair of the Department of Urology at Northwestern Memorial Hospital. Dr. Schaeffer, speak a little bit about the prevalence of prostate cancer among African American men.
Dr. Edward Schaeffer (Guest): Prostate cancer in general is the most commonly diagnosed non-skin cancer in men and the lifetime risk for an average person, any race, would be about one in seven in their lifetime in chance of being diagnosed. Now among men of African ancestry, the risk of being diagnosed with prostate cancer is higher. It’s about 1.8 fold or 1.8 times higher chance of being diagnosed with prostate cancer than a Caucasian man.
Host: Why is there such a disparity, Dr. Schaeffer, what factors contribute to the higher mortality rates among this demographic environment. Is it culture? It is biology or culture, access to care? Speak about some of the factors that figure into this.
Dr. Schaeffer: That’s a great question and I think we’re really at really the tip of the iceberg in terms of understanding what’s going on, but you touched on a lot of really important things. So I think access to healthcare is very important, and being tested, being screened in a timely fashion really, really matters. In addition we know that prostate cancers biologically are different, and in some cases can be more aggressive than prostate cancers in Caucasian men. So it’s a variety of factors that when you add them all up really do effect the chances of an African American man who’s diagnosed with prostate cancer will perhaps have a more aggressive type. So what does it mean – what does access to care mean? Well in the case of prostate cancer, access to care may mean that for example a man of African ancestry has less ability to get into a primary care physician to talk about screening for prostate cancer, or if they’re seeing a primary care physician, maybe they’re not really having the active discussion with them or maybe they have a discussion about screening and they’re scared, they don’t understand what it means and it’s something that they’re fearful about, and so having access those are good examples of the access. Now we know that in general on average men who are of African ancestry who are diagnosed with prostate cancer are diagnosed with a higher blood test value, so we screen for prostate cancer with a blood test, which is called a PSA blood test, or prostate specific antigen blood test, and if you look and you just say among all the African American men in the US who are diagnosed with prostate cancer, and all the Caucasians who are diagnosed with prostate cancer, are the screening test numbers the same? And the answer is they’re not; so they’re higher in African American men, and that may again reflect back and suggest that well maybe these men are getting tested later on, their disease has progressed more perhaps, which could be an access issue, but we also have research that’s out of my lab that suggests it’s not just access and the tumors, the cancers in African American men are actually biologically more aggressive, and so it’s – the short answer to the question was yep, a lot of the factors play a role, access plays a role, but biology also plays a role.
Host: Then please provide a brief overview of your research for other providers around the biologic differences in prostate cancers in men of African descent and how has this research improved the medical community’s understanding of prostate cancer, Dr. Schaeffer?
Dr. Schaeffer: Yeah that’s a great question. So just to take a step back, my research focuses on lethal prostate cancer. So when we diagnose someone with prostate cancer there are some types that are very, very aggressive. My research focuses on understanding the biologic drivers. What is making those cancers so, so aggressive. That’s the primary theme of my research. As I mentioned and you mentioned before, African Americans have a higher chance of being diagnosed with an aggressive lethal cancer. So the way I explained to people is well the basic premise of my work is really to understand the molecular biology of aggressive lethal prostate cancer, and to understand the different unique populations of men who are at risk for developing this aggressive lethal cancer. So African American men are at higher risk for developing this aggressive lethal cancer, and so really we’re doing a deep dive into the molecular biology into what makes these aggressive tumors aggressive, and then we’re also trying to separate out well are there differences in aggressive tumors between Caucasians and African Americans, and there are some overlaps but there are some unique features about cancers in African American men that may make them more aggressive, but also potentially we think maybe more susceptible to some unique emerging new therapies. So a lot of exciting work going on, and we’re always interested in finding answers to these unknown questions, and that’s really the main thrust of our lab.
Host: Well it certainly is, but are your findings different from what’s currently available? Is this very new information?
Dr. Schaeffer: Yeah, this work that I’m describing for you is hot off the press. So it’s been a series of studies that we’ve been doing over the years, but generally speaking the unique features, the molecular biologic features that made cancers aggressive is something that’s a newer observation coming out of our research program, and also what are the unique features that may make a cancer more aggressive in men of African ancestry is also very, very new and so we hope to translate some of these findings into clinical trials that really help us understand maybe how to harness these differences between the cancers and use them to the benefit of men of African ancestry, and that’s our goal for the next five years, which seems like forever maybe for our listeners, but in science and research, these are short timelines. So we’re developing a couple programs that we think may be very helpful for men of African ancestry, and we’re paralleling that with research, so we’re talking about clinical trials, ways to improve the care for these guys, and we’re trying to initiate these studies, and hopefully within the next several years we’ll have more answers.
Host: Is one of your findings, or is this even involved in your research, Dr. Schaeffer, weight loss and obesity in men of African descent to help normalize their disproportionate burden of aggressive disease you’ve been describing?
Dr. Schaeffer: Yeah that’s a great question, so like I said I’m interested in the factors of what are the molecular biologic reasons behind aggressive lethal cancers? So we’ve learned a couple things and so one of them are environmental reasons why cancers can maybe become more aggressive. So one of the things that we’ve learned is the environment does matter, and when we mean environment, we mean things like well actually where you live and what’s around you and so for example, is the actual individual a smoker? Are they surrounded by smokers? What’s their diet like? Do they have a healthy diet of a lot of green vegetables and fruit or is it an unhealthy diet with soda and chips and stuff? And that’s one way to think about the environment. The other way to think about the environment of the prostate is the actual person it resides in. So yes weight and obesity are definitely factors for both African Americans as well as Caucasians, and it’s thought that the more than individual weighs, the higher the chance that they would be potentially diagnosed with a cancer that’s a little bit more aggressive, and there’s a lot of complex reasons behind that but that’s certainly one factor. Then for example, smoking is the same thing. We know that young individuals, younger men, men under 50 who are smokers, they have a higher chance of being diagnosed with more aggressive prostate cancer. So the number of individuals who are Caucasian and the number of individuals as a percentage that are African American and smoke is about the same, and fortunately the rates of smoking in the US really rapidly declining. So yes there are environmental factors like weight and factors like smoking that can affect aggressive cancer, those effects are really equal among African Americans and Caucasians, as far as we know right now.
Host: How do you feel your research impacts patients as you get into these clinical trials, and also what do you want other providers to know? How do you feel it might impact physician’s treatment of aggressive Gleason scores, aggressive disease further on down the line?
Dr. Schaeffer: Yeah well it’s a great question again, and I think that what we’re really interested in is, I’m optimistic when all is said and done my work really highlights these differences in cancers between Caucasians and African Americans and really increases our awareness of some of the kind of subtleties of screening for prostate cancer and potentially treating prostate cancer. So that would be my ultimate goal, to increase awareness because I think awareness is really, really powerful. Awareness really reflects knowledge and I think knowledge is really king. So if my work could really remind people to think about unique factors that make an individual at increased risk for being diagnosed with aggressive cancer, maybe it’s smoking, maybe it’s weight, maybe it’s race, and having a thoughtful discussion with them about screening, that would be fabulous. And the good news is that we think, once we identify cancers in Caucasians and once we identify cancers in African Americans that then the playing field becomes very, very level, so that we have a good idea that once a patient’s initiated treatment, their outcomes can be equally good, independent of race, which is really, really good news for everyone listening. So I think that the key is to really increase awareness about screening. If you can increase awareness about screening and get everybody thinking about when is the right time for them to be tested, well that will be quite helpful, and if we can get people into the clinic at the same time and early time, then I think we can improve the outcomes for all men with prostate cancer.
Host: It’s really amazing the research that you’re doing, Dr. Schaeffer, wrap it up for us. What’s next when it comes to this area of study, what would you like other providers to know about your research or referring patients to you, getting involved in your clinical trials, kind of wrap it up, summarize it for us.
Dr. Schaeffer: Prostate cancer is a disease that effects men, and the men that it effects spans five or six decades of life, so thinking about screening for prostate cancer and treating them with prostate cancer is a very personalized decision and we take that decision very seriously at Northwestern Medicine in our Urology Clinics, and so I would really encourage people out there, if they have complex, difficult decisions with men about screening or treating their cancer, they should come visit us, and as part of that complex decision, we I think having discussions about clinical trials that may make sense for men is really important because I think ultimately that’s going to improve the outcomes for all of our patients out there.
Host: Thank you for joining us today, Dr. Schaeffer, and sharing your research on prostate cancer disparities with us. For more information on the latest advances in medicine, please visit nm.org, that’s nm.org. This is Melanie Cole, thanks so much for listening.
Prostate Cancer Disparity Research
Melanie Cole (Host): Welcome, today we’re talking about the latest research in prostate cancer disparities. My guest is Dr. Edward Schaeffer. He is the chair of the Department of Urology at Northwestern Memorial Hospital. Dr. Schaeffer, speak a little bit about the prevalence of prostate cancer among African American men.
Dr. Edward Schaeffer (Guest): Prostate cancer in general is the most commonly diagnosed non-skin cancer in men and the lifetime risk for an average person, any race, would be about one in seven in their lifetime in chance of being diagnosed. Now among men of African ancestry, the risk of being diagnosed with prostate cancer is higher. It’s about 1.8 fold or 1.8 times higher chance of being diagnosed with prostate cancer than a Caucasian man.
Host: Why is there such a disparity, Dr. Schaeffer, what factors contribute to the higher mortality rates among this demographic environment. Is it culture? It is biology or culture, access to care? Speak about some of the factors that figure into this.
Dr. Schaeffer: That’s a great question and I think we’re really at really the tip of the iceberg in terms of understanding what’s going on, but you touched on a lot of really important things. So I think access to healthcare is very important, and being tested, being screened in a timely fashion really, really matters. In addition we know that prostate cancers biologically are different, and in some cases can be more aggressive than prostate cancers in Caucasian men. So it’s a variety of factors that when you add them all up really do effect the chances of an African American man who’s diagnosed with prostate cancer will perhaps have a more aggressive type. So what does it mean – what does access to care mean? Well in the case of prostate cancer, access to care may mean that for example a man of African ancestry has less ability to get into a primary care physician to talk about screening for prostate cancer, or if they’re seeing a primary care physician, maybe they’re not really having the active discussion with them or maybe they have a discussion about screening and they’re scared, they don’t understand what it means and it’s something that they’re fearful about, and so having access those are good examples of the access. Now we know that in general on average men who are of African ancestry who are diagnosed with prostate cancer are diagnosed with a higher blood test value, so we screen for prostate cancer with a blood test, which is called a PSA blood test, or prostate specific antigen blood test, and if you look and you just say among all the African American men in the US who are diagnosed with prostate cancer, and all the Caucasians who are diagnosed with prostate cancer, are the screening test numbers the same? And the answer is they’re not; so they’re higher in African American men, and that may again reflect back and suggest that well maybe these men are getting tested later on, their disease has progressed more perhaps, which could be an access issue, but we also have research that’s out of my lab that suggests it’s not just access and the tumors, the cancers in African American men are actually biologically more aggressive, and so it’s – the short answer to the question was yep, a lot of the factors play a role, access plays a role, but biology also plays a role.
Host: Then please provide a brief overview of your research for other providers around the biologic differences in prostate cancers in men of African descent and how has this research improved the medical community’s understanding of prostate cancer, Dr. Schaeffer?
Dr. Schaeffer: Yeah that’s a great question. So just to take a step back, my research focuses on lethal prostate cancer. So when we diagnose someone with prostate cancer there are some types that are very, very aggressive. My research focuses on understanding the biologic drivers. What is making those cancers so, so aggressive. That’s the primary theme of my research. As I mentioned and you mentioned before, African Americans have a higher chance of being diagnosed with an aggressive lethal cancer. So the way I explained to people is well the basic premise of my work is really to understand the molecular biology of aggressive lethal prostate cancer, and to understand the different unique populations of men who are at risk for developing this aggressive lethal cancer. So African American men are at higher risk for developing this aggressive lethal cancer, and so really we’re doing a deep dive into the molecular biology into what makes these aggressive tumors aggressive, and then we’re also trying to separate out well are there differences in aggressive tumors between Caucasians and African Americans, and there are some overlaps but there are some unique features about cancers in African American men that may make them more aggressive, but also potentially we think maybe more susceptible to some unique emerging new therapies. So a lot of exciting work going on, and we’re always interested in finding answers to these unknown questions, and that’s really the main thrust of our lab.
Host: Well it certainly is, but are your findings different from what’s currently available? Is this very new information?
Dr. Schaeffer: Yeah, this work that I’m describing for you is hot off the press. So it’s been a series of studies that we’ve been doing over the years, but generally speaking the unique features, the molecular biologic features that made cancers aggressive is something that’s a newer observation coming out of our research program, and also what are the unique features that may make a cancer more aggressive in men of African ancestry is also very, very new and so we hope to translate some of these findings into clinical trials that really help us understand maybe how to harness these differences between the cancers and use them to the benefit of men of African ancestry, and that’s our goal for the next five years, which seems like forever maybe for our listeners, but in science and research, these are short timelines. So we’re developing a couple programs that we think may be very helpful for men of African ancestry, and we’re paralleling that with research, so we’re talking about clinical trials, ways to improve the care for these guys, and we’re trying to initiate these studies, and hopefully within the next several years we’ll have more answers.
Host: Is one of your findings, or is this even involved in your research, Dr. Schaeffer, weight loss and obesity in men of African descent to help normalize their disproportionate burden of aggressive disease you’ve been describing?
Dr. Schaeffer: Yeah that’s a great question, so like I said I’m interested in the factors of what are the molecular biologic reasons behind aggressive lethal cancers? So we’ve learned a couple things and so one of them are environmental reasons why cancers can maybe become more aggressive. So one of the things that we’ve learned is the environment does matter, and when we mean environment, we mean things like well actually where you live and what’s around you and so for example, is the actual individual a smoker? Are they surrounded by smokers? What’s their diet like? Do they have a healthy diet of a lot of green vegetables and fruit or is it an unhealthy diet with soda and chips and stuff? And that’s one way to think about the environment. The other way to think about the environment of the prostate is the actual person it resides in. So yes weight and obesity are definitely factors for both African Americans as well as Caucasians, and it’s thought that the more than individual weighs, the higher the chance that they would be potentially diagnosed with a cancer that’s a little bit more aggressive, and there’s a lot of complex reasons behind that but that’s certainly one factor. Then for example, smoking is the same thing. We know that young individuals, younger men, men under 50 who are smokers, they have a higher chance of being diagnosed with more aggressive prostate cancer. So the number of individuals who are Caucasian and the number of individuals as a percentage that are African American and smoke is about the same, and fortunately the rates of smoking in the US really rapidly declining. So yes there are environmental factors like weight and factors like smoking that can affect aggressive cancer, those effects are really equal among African Americans and Caucasians, as far as we know right now.
Host: How do you feel your research impacts patients as you get into these clinical trials, and also what do you want other providers to know? How do you feel it might impact physician’s treatment of aggressive Gleason scores, aggressive disease further on down the line?
Dr. Schaeffer: Yeah well it’s a great question again, and I think that what we’re really interested in is, I’m optimistic when all is said and done my work really highlights these differences in cancers between Caucasians and African Americans and really increases our awareness of some of the kind of subtleties of screening for prostate cancer and potentially treating prostate cancer. So that would be my ultimate goal, to increase awareness because I think awareness is really, really powerful. Awareness really reflects knowledge and I think knowledge is really king. So if my work could really remind people to think about unique factors that make an individual at increased risk for being diagnosed with aggressive cancer, maybe it’s smoking, maybe it’s weight, maybe it’s race, and having a thoughtful discussion with them about screening, that would be fabulous. And the good news is that we think, once we identify cancers in Caucasians and once we identify cancers in African Americans that then the playing field becomes very, very level, so that we have a good idea that once a patient’s initiated treatment, their outcomes can be equally good, independent of race, which is really, really good news for everyone listening. So I think that the key is to really increase awareness about screening. If you can increase awareness about screening and get everybody thinking about when is the right time for them to be tested, well that will be quite helpful, and if we can get people into the clinic at the same time and early time, then I think we can improve the outcomes for all men with prostate cancer.
Host: It’s really amazing the research that you’re doing, Dr. Schaeffer, wrap it up for us. What’s next when it comes to this area of study, what would you like other providers to know about your research or referring patients to you, getting involved in your clinical trials, kind of wrap it up, summarize it for us.
Dr. Schaeffer: Prostate cancer is a disease that effects men, and the men that it effects spans five or six decades of life, so thinking about screening for prostate cancer and treating them with prostate cancer is a very personalized decision and we take that decision very seriously at Northwestern Medicine in our Urology Clinics, and so I would really encourage people out there, if they have complex, difficult decisions with men about screening or treating their cancer, they should come visit us, and as part of that complex decision, we I think having discussions about clinical trials that may make sense for men is really important because I think ultimately that’s going to improve the outcomes for all of our patients out there.
Host: Thank you for joining us today, Dr. Schaeffer, and sharing your research on prostate cancer disparities with us. For more information on the latest advances in medicine, please visit nm.org, that’s nm.org. This is Melanie Cole, thanks so much for listening.