1. “The African American Prostate Cancer Crisis in Numbers”

2. The Numbers 1 Prostate cancer is the most commonly diagnosed cancer in African-American men. African Americans have the highest rate of prostate cancer diagnosis compared to all other men. African Americans have the highest prostate cancer death rate of all men. The African American prostate cancer death rate disparity is the highest for any type of major cancer.

3. Prostate Cancer Incidence & Mortality by Race 2009 *Source: National Cancer Institute SEER Stat Fact Sheet: Prostate 2012 **per 100,000 men per year (Excerpted from National Cancer Institute publication State Cancer Profiles) Estimated New Cases 241,740* Estimated Deaths 28,170*

4. Prostate Cancer and African-American Men 2 Prostate cancer is the 2nd leading cause of cancer-related deaths among black men. Black men are more than twice as likely to die of prostate cancer. 20 1 in 5 (20%) African-American men will be diagnosed with prostate cancer in their lifetime. 37 Prostate cancer accounts for approximately 37% of all cancers among Black men. 4,980 An estimated 4,980 deaths occurred among black men from prostate cancer in 2013. 35,430 An estimated 35,430 black men received prostate cancer diagnoses in 2013.

5. Lifetime Probability (%) of Developing Invasive Cancers by Race and Sex, US, 2007-2009 American Cancer Society. Cancer Facts and Figures for African Americans 2013-2014. Atlanta: American Cancer Society.

6. Lifetime Probability (%) of Dying from Invasive Cancers by Race and Sex, US, 2007-2009 American Cancer Society. Cancer Facts and Figures for African Americans 2013-2014. Atlanta: American Cancer Society.

7. Leading Sites of New Cancer Cases and Deaths among African Americans, 2013 Estimates Source: 2013, American Cancer Society, Surveillance and Health Services Research Estimated New Cases Estimated New Deaths

8. States with the Highest African-American Prostate Cancer Death Rates* ( 2005 – 2009 ) **Rates are per 100,000 population and age - adjusted to the 2000 US standard population

9. Focus on the Progress 40 The African American prostate cancer death rate declined by more than 40% from 1992 to 2010. 50 Cancer deaths among African-American men aged 40-49 decreased by 50% from 1991 to 2010 (faster than all other groups). This progress was made during a period of emphasis on early detection screening (PSA and DRE testing). Early detection efforts among African Americans now equal to whites.

10. Prostate Cancer Death Rates* by Race and Ethnicity, U.S., 1999–2010 Mortality source: U.S. Mortality Files, National Center for Health Statistics, CDC. *Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130). Death rates cover 100% of the U.S. population.

11. Prostate Cancer Survival and Stage Distribution The overall 5-year relative survival rate among African Americans is 96% to nearly 100% among whites. Ninety-one percent of all prostate cancers among African Americans are diagnosed at a local or regional stage, compared to 93% in whites. The 5-year relative survival rate for African Americans whose tumors are diagnosed at these early stages approaches 100%. Among African American men, the 5-year survival rate drops to 28% when the cancer has spread to distant sites. American Cancer Society. Cancer Facts and Figures for African Americans 2013-2014. Atlanta: American Cancer Society.

12. Imminent Risks to Further Progress De-emphasis on Early Detection Testing In 2012, the United States Preventive Services Taskforce recommended that doctors stop PSA screening regardless of age, race, and family history, unless a man shows symptoms. –This recommendation has resulted in a decrease in PSA testing. “These effects were more immediate and pronounced in the urban/academic setting, and more gradual in suburban and rural settings…” Source: Aslanai, A. et al. (2013 December 14). The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System. Journal of Urology.

13. The Prostate Cancer Conundrum A ten year decline in prostate cancer deaths -versus- Concerns about over-diagnosis and over-treatment –Based on clinical trials that included average risk white men Clinical Trials and Research Studies –PSA clinical trials did not include African-American participants –Impossible to know the African-American response –Research indicates African Americans are diagnosed at an earlier stage and with more advanced disease progression.

14. PHEN’s Position Stay the course that produced progress Focus on reducing over-treatment –New tests are now available to help men determine whether treatment or active surveillance is the best course Increase education and awareness outreach

15. PHEN Early Detection Guidance 1.Baseline PSA testing for African American and other men deemed to be at high risk for prostate cancer is suggested beginning at “age 40” for predicting their future risk of prostate cancer. 2.PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection. 3.A prostate cancer diagnosis must be uncoupled from prostate cancer intervention Based on PHEN’s Consensus Statement, September 2013

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