University of Alberta researchers contributed to a study that found Indigenous men receive testing for prostate cancer at lower rates and have worse survival outcome predictions at diagnosis.
Dr. Adam Kinnaird, an author on the study, explained that the prostate is an essential part of the male reproductive system. It lives in the pelvis of males, and produces a fluid that makes up a part of semen. Dr. Kinnaird is an assistant professor in the faculty of medicine and dentistry. He is also the Frank and Carla Sojonky Chair in Prostate Cancer Research.
The paper has a number of co-authors and contributors, many of whom are Indigenous.
Wayne Clark, the executive director of the Indigenous Health Program at the U of A, is the second author. Others credited are Rick Lightning, the resident Mosom (Elder) for the faculty of medicine and dentistry; Randy Littlechild, the Executive Director of Maskwacis Health Services; and Angeline Letendre, a researcher in Indigenous Health Research at Alberta Health Services (AHS).
Dr. Kinnaird said it was important that “with research like this, there is Indigenous community support and Indigenous buy-in.”
“We did have a lot of Indigenous authors and people contributing to this research to make sure that we’re keeping with the norms, wants, and beliefs of Indigenous men.”
“Indigenous men were more likely to be diagnosed with higher prostate specific antigen, higher stage, and higher grade disease at the time of diagnosis”
According to the Canadian Cancer Society, a healthy prostate produces prostate specific antigen (PSA). However, someone with prostate cancer will have a higher amount of PSA in their blood.
Dr. Kinnaird and his colleagues observed a group of 6,049 men, all of whom had been diagnosed with prostate cancer prior to joining the study, between June 2014 and October 2022.
Dr. Kinnaird said that cancer metastasis was found to be a more likely outcome for Indigenous men. Regarding prostate cancer, metastasizing is when the cancer spreads beyond the prostate.
“Indigenous men were more likely to have their prostate cancer metastasized than non-Indigenous men during our follow-up period,” Dr. Kinnaird said.
As a part of regular health maintenance, males between the ages of 50 and 70 receive screening. They have their PSA levels checked by a blood test, and receive a digital rectal examination to check for abnormalities.
The researchers examined prostate cancer screening rates by looking at over 1.4 million PSA tests of males in Alberta. They found Indigenous men were less likely to receive PSA tests than non-Indigenous men.
“Men living in Indigenous communities had about a 50 per cent lower rate of prostate cancer screening than men living in other communities”
Approximately one in eight Canadian men will develop prostate cancer within their lifetime. Dr. Kinnaird emphasized the commonality of the disease, as well as the importance of an early diagnosis.
“Prostate cancer is the most common internal [tumour] in men in Canada,” Dr. Kinnaird explained. “It is something that is very curable when caught early, but once it metastasizes it’s incurable.”
The researchers plan for follow-up studies. They will be receiving data from the Alberta Tomorrow Project (ATP) related to PSA testing. Dr. Kinnaird describes ATP as “a big observational cohort study of about 55,000 Albertans.”
“We’ll be able to [figure] out both in urban and rural settings if these differences in prostate cancer diagnosis exist between Indigenous and non-Indigenous men. We’ll also be able to see if there are differences in terms of prostate cancer screening between the two populations.”
The researchers have also received a grant to study germline mutations. Germline mutation is a mutation that gets incorporated into a persons deoxyribonucleic acid (DNA). It can then be passed on to children. They hope to understand the rate of mutation in the DNA of Indigenous men. As an example, Dr. Kinnaird mentioned that the Ashkenazi Jewish population has a higher rate of mutations that predispose them to prostate cancer.
“[This is] something that would be important to know because this would change when you would start screening [Indigenous men]. You would start screening them at an earlier age,” Dr. Kinnaird said. “And [there are] certain therapies that you can offer based on these mutations specifically.”