Diabetes Subtypes and Lethal Prostate Cancer Across Puerto Rican, African American, and Non-Hispanic White Veterans
Abstract
Puerto Rican men have a higher prostate cancer mortality compared to non-Hispanic White men or Hispanic men living in the continental U.S. Indeed, prostate cancer mortality among Puerto Rican men is second only to Black men in the U.S. However, prostate cancer in Puerto Rico remains largely uninvestigated. The majority of past studies combined men from all Spanish-speaking regions into a single group, usually labeled as Hispanic or Latino, and thus ignored the potential differences in culture, economics, lifestyle, or genetic risk between these regions that could impact prostate cancer risk and prognosis. Our analyses of prostate cancer patients treated with radical prostatectomy at the San Juan Veterans Administration (VA) Medical Center found that men in Puerto Rico have a significantly higher prostate cancer mortality than other VA Medical Centers, despite patients in Puerto Rico having better prognostic markers and less advanced tumors at diagnosis. Indeed, prostate cancer is the most common invasive malignancy diagnosed in Puerto Rico and, at present, the reasons why men in Puerto Rico have a higher prostate cancer mortality than other Hispanic or non-Hispanic White communities is unknown. One potential explanation is that Puerto Rico has the highest prevalence of Type 2 diabetes among all U.S. states and territories. Approximately 27% of Puerto Ricans report having diabetes compared to 16% in the continental U.S. We, and others, have reported that prostate cancer patients with diabetes (especially obese diabetics) have a poorer prognosis, however the research on this question is inconsistent. One challenge is that diabetes is not one disease, but rather recent studies suggest diabetes can be divided into multiple different types of diabetes, and patients who appear to have a similar type of diabetes may vary widely in their response to treatment. Indeed, in work supporting this concept, we describe a significant interaction between diabetes and obesity, such that among obese men, diabetes was associated with an overall 3-fold increased risk of prostate cancer death. In contrast, diabetes was unrelated to prostate cancer death among non-obese men. This suggests the complex metabolic dysregulation found in obese diabetics affects prostate cancer prognosis. However, this analysis was in a largely non-Hispanic White study population, and it is unclear whether race/ethnicity differences in the pathology of diabetes contribute to race/ethnicity differences in prostate cancer progression. The purpose of this study is to test the idea that differences in how diabetes and obesity interact between Puerto Rican, non-Hispanic White, and Black men may help to explain an unexpectedly high prostate cancer mortality in Puerto Rico. We propose a series of new studies that compares the effects of diabetes and obesity on prostate cancer prognosis among Puerto Rican patients seeking care at the San Juan VA Medical Center to Black and non-Hispanic White patients seeking care at the Durham VA Medical Center in North Carolina. Our first study will determine whether diabetes interacts with obesity to increase lethal prostate cancer in Puerto Rican men or Black men, similar to what we previously saw in White men. As both diabetes and lethal prostate cancer are more prevalent in Puerto Rico, we hypothesize a link between diabetes and obesity leading to lethal prostate cancer, which will be stronger among Puerto Rican men compared to non-Hispanic White or Black men. Our second study will recruit diabetic prostate cancer patients in San Juan, and we will compare gene expression pathways in prostate tissue among Puerto Rican, Black, and non-Hispanic White patients (the non-Puerto Rican men have already been accrued). Our analysis will be the first to investigate the impact of diabetes on prostate tissue across Puerto Rican, Black, and non-Hispanic White men. Our findings can then be translated to personalized clinical interv
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210982
Entities
People
- Jay Fowke
Organizations
- United States Army
- University of Tennessee Health Science Center