Enriching gene expression profiles will help personalize prostate cancer management for African-Americans: A perspective

Prostate cancer (PCa) remains the most common form of cancer affecting men in the Western Hemisphere. Mortality rate is 130% higher among African-American men (AAM) than Caucasian-American men. As this trend is not new nor changing, there is an urgent need to identify markers with the ability to specifically distinguish aggressive PCa in the context of race. Gene expression patterns have been used as a tool to identify prognostic biomarkers for PCa to help reduce this disparity. Gene expression profiles reveal molecular mechanisms useful in understanding the biologic basis of tumorigenesis. Thus far, gene expression profiling analyses focused on race between AAM and Caucasian-American men (CAM) demonstrated distinct tumor microenvironments in the tumor-adjacent stroma and pathways associated with inflammation, lipid metabolism, and regulation of epithelial-to-mesenchymal transition. Additionally, we and others have established that hypoxia, another component of the tumor microenvironment, can been linked to malignant progression, metastasis, resistance to therapy, and poor clinical outcome in PCa. Gene expression panels, including distinct components related to the biology of PCa in AAM, may increase prognostic accuracy for this ethnic group. Furthermore, reference gene expression patterns, especially in the context of the emerging molecular taxonomy of PCa, would be buttressed by including more AAM in their development to consider the aspects of expression profiles differentially associated with race.