Black men with prostate cancer have historically had worse outcomes than white men with prostate cancer. The causes of this disparity in outcomes are multi-factorial, but a potential basis is that prostate cancers in Black men are biologically distinct from prostate cancers in white men. Evidence suggests that genetic and ancestral factors, molecular pathways involving androgen and non-androgen receptor signalling, inflammation, epigenetics, the tumour microenvironment and tumour metabolism are contributing factors to the racial disparities observed. Key genetic and molecular pathways linked to prostate cancer risk and aggressiveness have potential clinical relevance. Describing biological drivers of prostate cancer disparities could inform efforts to improve outcomes for Black men with prostate cancer.
Genetic and ancestral factors, molecular pathways involving androgen and non-androgen receptor signalling, inflammation, epigenetics, the tumour microenvironment and tumour metabolism are posited as biological factors that potentially contribute to racial disparities in Black men with prostate cancer.
Key points: Black men have higher rates of prostate cancer and more aggressive disease than white men.Black men have biologically distinct prostate cancers from white men, including genetic alterations, protein differences, tumour microenvironment, and even circulating hormones and vitamins that might contribute to the differing phenotype of prostate cancers from Black men compared with white men.Socioeconomic status has an important role in the disparities in prostate cancer seen in Black men compared with white men, but it does not fully explain the differences.The biological differences between prostate cancers from Black men and white men could provide targets for therapies and precision medicine for Black men that can aid in addressing disparities in treatment outcomes between the two groups.More research focused on Black men to elucidate how these biological differences can be used to develop targeted treatments, including increased clinical trial participation, is needed.