Frank Chinegwundoh

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

BackgroundAfrican 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.ResultsSeveral 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.ConclusionThe 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.

Stilboestrol plus adrenal suppression as salvage treatment for patients failing treatment with luteinizing hormone‐releasing hormone analogues and orchidectomy

Objective To investigate the efficacy of low‐dose stilboestrol (SB) with hydrocortisone in patients with advanced prostate cancer refractory to androgen suppression.

Risk and presenting features of prostate cancer amongst African-Caribbean, South Asian and European men in North-east London.

To determine whether there are ethnic differences in the incidence and presenting features of all patients with prostate cancer presenting in North‐east London, UK.

The Management of Aspirin in Transurethral Prostatectomy: Current Practice in the UK

INTRODUCTION Stopping aspirin prior to transurethral prostatectomy (TURP) may minimise peri-operative blood loss, but it may also increase the risk of a significant cardiovascular event. There are no guidelines on the management of aspirin in TURP. This study sought to determine the variation in the peri-operative management of transurethral prostatectomy (TURP) patients that are taking aspirin. MATERIALS AND METHODS A questionnaire was sent to 444 consultant urologists in the UK from a list obtained from the British Association of Urologists. This resulted in 290 anonymous replies (65%), of which 287 were suitable for analysis. RESULTS Of these 287 urologists, 178 (62%) ask patients to stop aspirin prior to TURP. Aspirin is stopped 9.8 days (median, 10 days; range, 2-30 days) prior to surgery, and recommenced 8.8 days (median, 7 days; range, 1-42 days) after surgery. In those that stop aspirin, 62% will stop aspirin in all patients, regardless of the indication, and 40% will cancel a TURP if aspirin use has inadvertently continued. Of the 287 urologists, 109 (38%) do not stop aspirin. CONCLUSIONS There is a wide variation in the management of aspirin in TURP patients in the UK. Aspirin is being stopped in patients at high risk of serious cardiovascular disease, often for longer than necessary. There is a need for multidisciplinary guidelines to reduce variation in practice.

Testicular Varicocele: An Overview

Testicular varicocele or varicocele is one of the common causes of scrotal swelling. It is predominantly found in the adolescent and young adult age group and it can adversely affect testicular function in a variety of ways. There is a considerable debate about the effects of varicoceles on future fertility, but the current evidence suggests that varicoceles are found in a higher percentage among males attending the infertility clinics and that treatment of varicoceles is associated with increased spontaneous conception rates among infertile couples. In this article we give an overall view on the aetiology, adverse effects and management of varicoceles.

Pathways to diagnosis for Black men and White men found to have prostate cancer: the PROCESS cohort study

Black men in England have three times the age-adjusted incidence of diagnosed prostate cancer as compared with their White counterparts. This population-based retrospective cohort study is the first UK-based investigation of whether access to diagnostic services underlies the association between race and prostate cancer. Prostate cancer was ascertained using multiple sources including hospital records. Race and factors that may influence prostate cancer diagnosis were assessed by questionnaire and hospital records review. We found that Black men were diagnosed an average of 5.1 years younger as compared with White men (P<0.001). Men of both races were comparable in their knowledge of prostate cancer, in the delays reported before presentation, and in their experience of co-morbidity and symptoms. Black men were more likely to be referred for diagnostic investigation by a hospital department (P=0.013), although general practitioners referred the large majority of men. Prostate-specific antigen levels were comparable at diagnosis, although Black men had higher levels when compared with same-age White men (P<0.001). In conclusion, we found no evidence of Black men having poorer access to diagnostic services. Differences in the run-up to diagnosis are modest and seem insufficient to explain the higher rate of prostate cancer diagnosis in Black men.

Clinical presentation and initial management of Black men and White men with prostate cancer in the United Kingdom: the PROCESS cohort study

Background:In the United States, Black men have a higher risk of prostate cancer and worse survival than do White men, but it is unclear whether this is because of differences in diagnosis and management. We re-examined these differences in the United Kingdom, where health care is free and unlikely to vary by socioeconomic status.Methods:This study is a population-based retrospective cohort study of men diagnosed with prostate cancer with data on ethnicity, prognostic factors, and clinical care. A Delphi panel considered the appropriateness of investigations and treatments received.Results:At diagnosis, Black men had similar clinical stage and Gleason scores but higher age-adjusted prostate-specific antigen levels (geometric mean ratio 1.41, 95% confidence interval (95% CI): 1.15–1.73). Black men underwent more investigations and were more likely to undergo radical treatment, although this was largely explained by their younger age. Even after age adjustment, Black men were more likely to undergo a bone scan (odds ratio 1.37, 95% CI: 1.05–1.80). The Delphi analysis did not suggest differential management by ethnicity.Conclusions:This UK-based study comparing Black men with White men found no evidence of differences in disease characteristics at the time of prostate cancer diagnosis, nor of under-investigation or under-treatment in Black men.

Virtual cystoscopy from computed tomography: a pilot study

To assess the feasibility of virtual cystoscopy reconstructed from helical computed tomography (CT) obtained using an intravenous contrast agent, and to correlate the findings with flexible (FC) and rigid cystoscopy (RC) in patients with bladder tumours.

Treating stuttering priapism

Whats known on the subject? and What does the study add?

DIFFERENCES IN THE EPIDEMIOLOGY AND PRESENTATION OF PROSTATE CANCER IN BLACK AND WHITE MEN IN ENGLAND: LESSONS LEARNT FROM THE PROCESS STUDY

COMMENT COMMENT DIFFERENCES IN THE EPIDEMIOLOGY AND PRESENTATION OF PROSTATE CANCER IN BLACK AND WHITE MEN IN ENGLAND: LESSONS LEARNT FROM THE PROCESS STUDY Yoav Ben-Shlomo, Simon Evans, Biral Patel, Ken Anson*, Gordon Muir † , Raj Persad ‡ , Chris Metcalfe and Frank Chinegwundoh §¶ on behalf of the PROCESS Study Group – Department of Social Medicine, University of Bristol, Bristol, *Department of Urology and Pathology, St George’s Hospital, London, Departments of Urology, † King’s College Hospital NHS Trust, London, ‡ United Bristol Healthcare Trust, Bristol, § Barts and the London Hospital NHS Trust, and ¶ Newham University Hospital NHS Trust, London, UK