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This article reports the results of a pathoepidemiological study of a cohort of black men who had prostatic surgery at Howard University Hospital between 1968 and 1989. The median age of patients at diagnosis of prostate cancer increased by 8 years during the study period, indicating either a delay in seeking medical care or a true delay in onset of the disease. The trends of prevalence of biopsies with cancer in various age groups suggested a sharp rise in the incidence of prostate cancer after the age of 70. The significant increase in popularity of needle biopsy during the period 1982 to 1989 after a 7-year plateau is an indication of increased perceived value of this procedure with experience and technical improvement. The prevalence of biopsies with cancer in all successive time periods of the study showed a bimodal distribution with an early hump in the 50- to 54-year-old age group. This hump is analogous to the break in the rising incidence of breast cancer between the ages of 47 and 52 (Clemmesen hook). This similarity could be explained on the basis of hormonal dependence of the two cancers.

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A number of studies compared the clinical features and demographic characteristics of black and white patients with diseases of the breast. Only a few, however, dealt with the pathology of breast lesions. In this study, the distribution of breast lesions in blacks and whites (Caucasians) in the accessioned material of the AFIP from 1980 to 1983 was described. Additionally, the distribution of estrogen and progesterone receptors in a total of 425 black patients with breast cancer at Howard University Hospital was studied and the results compared with similar data reported in white American women. In the period January 1, 1980, to January 1, 1983, there were 380 breast lesions from black patients and 3511 comparable lesions from white patients accessioned at the AFIP. A total of 159 black women and 1819 white women were diagnosed with carcinoma of breast. Black patients had 102 (79 percent) invasive duct carcinomas, and white patients had 1112 (78 percent). Black patients with invasive duct carcinoma were generally younger than white patients, as 68 percent of black patients and 53 percent of white patients were younger than 54 years. The difference in age distribution was statistically significant. Lobular carcinoma was less common in blacks than in whites. The relative ratio frequency of mucinous, medullary, and papillary carcinoma was higher in black women than in whites. Tubular carcinoma, however, was more common in whites than in blacks. Black patients had a lower incidence of ER-positive tumors and a higher incidence of ER-negative tumors compared with published data on white patients. Postmenopausal patients were more likely to be ER positive than premenopausal patients. Stratification of the data indicated a lower incidence of ER-positive and a higher incidence of ER-negative breast cancers in both premenopausal and postmenopausal patients compared with published data from institutions with predominantly white patient populations. Microscopic examination revealed a higher frequency of poorly differentiated carcinomas and fewer well- and moderately well-differentiated carcinomas than has been reported for white women with the tumor. There was a significant correlation between tumor grade and receptor positivity. Well-differentiated carcinomas were more likely ER and PR positive than poorly differentiated ones.(ABSTRACT TRUNCATED AT 400 WORDS)

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Step-sections of 429 whole prostate glands were studied. Large acinar atypical hyperplasia was graded as mild, moderate, and severe based on the degree of cellular anaplasia. The relationship between atypical hyperplasia and prostatic carcinoma was investigated. There was a strong association between prevalence and grade of atypical hyperplasia and prostatic carcinoma in patients up to 60 years old. Beyond the age of 60 no association was detected. In the younger age groups (36 to 60 years) atypical hyperplasia was found in 86.8% of prostates with carcinoma, but only in 37.9% of benign glands. Corresponding figures for the over-60 age group were 68.8% and 65.1%, respectively. A biologic explanation of the association between atypical hyperplasia and carcinoma in the younger age groups has been proposed. It was suggested that these men with atypical hyperplasia, particularly with severe atypical hyperplasia, have a greater risk for developing prostatic carcinoma.

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This is a one-to-one, age- and race-matched case-control study involving 55 histologically confirmed black prostate cancer patients and 55 controls who were seen at three major hospitals in Washington, DC from 1982 to 1984. Personal interviews were conducted to obtain the number of times food items of specified serving size were consumed per week by cases and controls; the subjects were grouped according to the age periods 30-49 and 50 years and older. We then calculated the average daily consumption of each of 18 nutrients per 1,000 calories. There was a significant negative association between linoleic acid (p less than 0.04) for the 50 years and older group, thiamin (p less than 0.05) for those 30-49 years old, riboflavin (p less than 0.03) for the 50 and older group, and iron (p less than 0.05) for those 30-49 years old. The results of this study suggest that the intake of thiamin and iron (in subjects 30-49 years old), linoleic acid and riboflavin (in subjects 50 years and over) could be protective because control subjects consumed more of these nutrients than did the cases.

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Autopsy protocols at Howard University Hospital (HUH), Washington, DC, for the period of 1930 to 1985 were reviewed. The patient population of the hospital is predominantly black. Necropsy cases with adenocarcinoma of the prostate were tabulated according to the presence or absence of metastasis and the site of the metastatic lesion. A comparison was made with a similar racially unselected (predominantly white) series (Massachusetts General Hospital).The most commonly involved organs by secondary carcinoma of the prostate were, in descending order of frequency, lymph nodes, bones, bladder, lung, liver, and kidneys. In comparison with the MGH unselected series, the distribution of metastatic sites was significantly different (P < .0001). In the HUH series, kidney and adrenal gland metastases were more common than in the control series. The seminal vesicles were more frequently involved in the MGH series. In the HUH series, 76 percent of bone metastases occurred in the vertebrae, while the comparable figure for the MGH series was 40 percent.

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The histologic appearances of ductal invasion were studied in 139 cases of prostatic adenocarcinoma diagnosed in the Department of Pathology, Howard University Hospital, during the period January 1980 through October 1983. Intraductal spread was found in almost half (48%) of the prostatic glands examined. Ductal spread was associated with the local extent (P less than 0.001) rather than with the grade of the tumor (P less than 0.01). Three distinct patterns of ductal penetration were recognized. The duct wall was completely destroyed in microinvasion. In foci of ductal permeation the integrity of the basement membrane was generally preserved, and the duct wall was infiltrated mainly by solitary tumor cells. When the tumor spread was by extension in continuity within the duct wall, the neoplastic cells appeared to grow between the pre-existing epithelial layers. It was concluded that prostatic carcinoma cells have the ability to penetrate the wall of benign ducts and progressively replace the normal epithelial elements. In this process the general framework of the affected duct appears to be preserved.

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This one-to-one, age- and race-matched case-control study involved 181 histologically confirmed black prostate cancer patients and 181 controls seen at three major hospitals in Washington, DC, during the period 1979-1982. Personal interviews were conducted to obtain the number of times food items of specified serving size were consumed per week by cases and controls during the age periods 30-49 and 50 years and older. Then the average daily consumption of each of 18 nutrients per 1,000 calories was calculated. There was risk enhancement associated with increased intake of proteins, total fat, saturated fat, oleic acid, and vitamin A during the age period 30-49 years. The association was highly significant for vitamin A and approached statistical significance for the other four nutrients. A hypothesis based on disturbance of the zinc-retinol binding protein-vitamin A axis was put forward to explain the relative risk enhancement effect of vitamin A on prostate cancer.

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Age-related changes of arteries, veins, glands, and stroma in the prostate of black men from Washington, DC, and from Ibadan, Nigeria, and Accra, Ghana, West AFrica, were studied in a total of 795 consecutive, unselected prostate specimens removed at autopsy during a 7-year period (1973-1980). Except for age group 80 and over, aging changes in the prostate were more severe in all age groups in black men from Washington, DC, than in black men from Ibadan and Accra (P less than 0.01). However, when the intensity of age-dependent alterations was compared in either US or African black men with carcinoma and with no carcinoma, no significant differences were found. These findings do not support the idea that the aging process per se increases susceptibility to cancer.

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Microcarcinoma (incidental, latent) of the prostate gland occurred with a frequency of 11.7% and at an age-adjusted incidence rate (world standard) of 40.6% per 1000 necropsies in the sampled black male population. The frequency of microcarcinoma of the prostate in black males in Washington, D.C., is essentially the same as the frequency of latent carcinoma in other ethnic groups and in other geographic areas. Of the patients studied clinically, fifty-one percent (51%) were in low stage (Stages I and II) disease; sixty-three percent (62.7%) had a well differentiated, Grade I, carcinoma of the prostate; and forty-two percent (42.4%) were in the 65-74 age group. Mean plasma testosterone and estrone levels were significantly higher in cancer patients than in age-matched hospitalized controls. The factor with the highest risk ratio was urinary tract symptoms occurring 10 years or longer before the onset of the present complaints which led to the diagnosis or prostatic carcinoma. Although our studies did not directly implicate diet as a risk factor, published reports strongly suggest diet as a critical factor in the development of prostatic carcinoma.

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A comparison of carcinoma of the prostate gland in a low-incidence Nigerian (Ibadan) population and a high-incidence U.S. Afro-American (Washington, D.C.) population was the purpose for this study, initiated in 1973. The frequency of carcinoma (micro- and invasive) was determined in consecutive necropsy cases from hospitals in Ibadan, Nigeria, Accra, Ghana and Washington, D.C. The results of these clinical, epidemiologic and morphologic studies are reported. Clinically, the peak incidence of carcinoma of the prostate in Nigerian males in Ibadan and in American males in Washington, D.C. was in the 65-74 age group. The median age of patients was 66.4 years in Ibadan and 69.2 years in Washington, D.C. Seventy-five percent of Nigerian and 49% of American patients were in stages III and IV. Overall, the distribution by grade of neoplasms in surgical material from Ibadan and Washington, D.C. was similar. Plasma testosterone and estrone levels were significantly higher (p < 0.05 and p < 0.001) in U.S. patients than in U.S. controls and higher (p < 0.001 and p < 0.05) in U.S. patients than in Nigerian patients with prostatic carcinoma. Plasma testosterone levels were significantly lower (p < 0.05) in Nigerian patients than in Nigerian controls. Estrone levels were not significantly different in Nigerian patients than controls. Nigerian patients were more sexually active throughout their lives than American patients; however, they reported a higher incidence of impotence than U.S. patients in the immediate 5 years preceding the diagnosis of prostatic carcinoma. Nigerian respondents (patients and controls) arrived at puberty later than their American counterparts. Within each of the two population groups, the factor with the highest relative risk ratio was lower urinary tract symtoms occurring 10 years or longer before the onset of the present complaints which led to the diagnosis of prostatic carcinoma. Nigerian and U.S. patients were more sexually active than controls. Microcarcinoma (incidental, latent) of the prostate gland occurred with a frequency of 11.8% and at an age-adjusted incidence rate (world standard) of 40.6 per 1000 necropsies in the sampled U.S. black male population. The age-adjusted incidence rate (world standard) for microcarcinoma in the combined West African (Accra and Ibadan) series (36.7/1000) was almost equal to the rate (40.6/1000) in the Washington, D.C. series.

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The incidence of calcification in the prostate gland of black men from Washington, D.C., and from Ibadan, Nigeria, and Accra, Ghana, West Africa, was assessed in a total of 874 consecutive, unselected prostate specimens removed at autopsy during a five-year period (1973--1978). In the combined series there was a significant positive association between prostatic calcification and age (p less than 0.001). The frequency of calcification was significantly higher in the Washington, D.C. series than in the West African series at all age levels (p less than 0.001). This difference most likely reflects the different dietary patterns of the two population groups.

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A clinical and pathologic comparison of carcinoma of the prostate in a high-risk US (Washington, DC) black population and in a low-risk Nigerian (Ibadan) black population is presented. Fifty-two percent of American patients were in clinical stages I and II, whereas only 10% of Nigerian patients were in the same stages. Testosterone and estradiol blood levels were significantly lower (P less than 0.05) in patients with carcinoma of the prostate from Ibadan compared with American black prostate cancer patients from Washington, DC. Age-standardized incidence rates (world standard) for 1000 autopsies for micro (incidental)-carcinoma were approximately equal in American and African black men. The incidence rate of invasive carcinoma was, however, even after adjustment for age, higher in American black men than in African men.

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During the period 1960 through 1969, 990 primary neoplasms of the central nervous system were diagnosed in hospitals in the Washington, DC, Standard Metropolitan Statistical Area (SMSA). All cases were identified according to age, race, sex, histologic type, and date of diagnosis. A West African composite of 253 cases was used for comparison. In the Washington SMSA, the age-adjusted incidence rates were: for Caucasians 5.5 in males and 3.6 in females and for Negroes 4.8 in males and 3.4 in females per 100,000 annual population. Caucasians in the Washington SMSA had a higher relative proportion of gliomas than Negroes in the same area and in Africa (p less than 0.005). The relative proportion of pituitary adenomas was higher in American Negroes (p less than 0.005) and in Africans than in Caucasians. The comparable pattern of CNS tumors in American and African Negroes, relative to Caucasians, suggests that in the development of neoplasms of the central nervous system racial factors may be of importance.

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The curves for death rates from prostatic cancer and gonorrhea incidence rates in Denmark, over a span of thirty years, matched well with a lag period of forty-five years. Moreover, a retrospective study conducted in the United States involving 75 cancer patients and 75 age-matched controls demonstrated a statistically significant association between gonorrheal infection and subsequent development of prostatic carcinoma. Two postulates are presented: the viral-venereal and the chronic infection theories. The recent increase in incidence of prostatic cancer in the United States could be the beginning of an epidemic in which astronomically high rates may be reached.

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This study was designed to compare United States (Washington, DC) black prostatic carcinoma patients (high-risk group) with Nigerian (Ibadan) black prostatic carcinoma patients (low-risk group). Although the material is meager, preliminary analyses suggest that carcinoma of the prostate is a common disease in both US black men (196 of 1000 autopsies) and in Nigerian black men (67 of 1000 autopsies). The tumor tends to be of a higher histologic grade (less well differentiated) and the carcinomatous foci are more numerous in the Nigerian patients. Fifty-three percent of US patients are in stages I and II when the disease is first discovered. Plasma testosterone, estrone, and estradiol concentrations did not differ significantly between US patients and controls. A statistically significant positive association is indicated between carcinoma of the prostate and the following epidemiologic variables: racial admixture, age of puberty, and age of first coitus. The median age of necropsy cases with carcinoma was 50.0 years in Nigeria and 68.3 years in the US.

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