The greater Baltimore area in Maryland has a large population of African-Americans and European-Americans, which makes this area most suitable to investigate differences in the exposure to prostate cancer risk factors among these two population groups. We designed a study that will use an integrated molecular epidemiology and translational research approach to examine causes for the excessive burden of prostate cancer among African-American men, including the study of tumor biological differences between African-American and European-American patients, supported by the collection of blood, urine, tissue samples, and survey data. Other epidemiological studies of prostate cancer have been established in recent years; however, only a few of these studies address the need for health disparity research and will have the opportunity to collect fresh-frozen tumor specimens from case subjects. Our study was implemented in two phases. The first phase, which started in April of 2005, constituted a pilot study to evaluate recruitment procedures. This phase was successful and the full study was initiated with minor changes to the protocol in April of 2006. Study participants will be African-American and European-American males who reside in Baltimore city and surrounding areas. The study will recruit 1000 prostate cancer cases and 1000 population-based controls, with recruitment ending in 2015. The cases are recruited at two Baltimore hospitals, the Veterans Affairs Medical Center and the University of Maryland Medical Center. Cases will have pathologically confirmed prostate cancer. The population-based controls are identified through the Maryland Department of Motor Vehicles database, and are frequency-matched by age and race to cases. The study involves the administration of a survey and collection of blood and urine from all study subjects. Fresh-frozen tumor specimens will be obtained from cancer patients if it is available after prostatectomy. The study survey evaluates tobacco use, medication use, occupational history, diet, medical and sexual history, familial cancer history, and socioeconomic status. The study is supported by an epidemiological infrastructure that has been developed by our resource contractor at the University of Maryland for a lung cancer case-control study. This lung cancer study is ongoing, and the controls that are recruited for the prostate cancer study are joint controls with the lung cancer study. Hence, population-based male controls recruited by our contractor have double eligibility for the concurrent lung and prostate cancer studies. To achieve an age and race matching of cases and controls in the prostate study, we will over-sample for male controls in the lung cancer study. This study and the ongoing lung study are described by a recently established website at (http://home.ccr.cancer.gov/GEMES/index.html). The website also describes the policy for collaborations involving data sharing. Our study is aimed at identifying differences in risk factor exposure and tumor biology between African-American and European-American men. We will also test the hypothesis that environmental and genetic factors and their interactions contribute to the existing prostate cancer health disparity among African-Americans and European-Americans. Molecular work will be used to examine race/ethnic differences in tumor biology. Currently, we have enrolled 950 cases (480 European-Americans and 470 African-Americans) and completed recruitment of the population-based controls (1000: 500 European-Americans and 500 African-Americans). We collected blood and urine from these individuals and paraffin-embedded and fresh-frozen tissue specimens form 135 prostatectomy surgeries. Recruitment of cases will be completed in 2015. Lastly, we are in the process of obtaining disease recurrence and national death index data for all cases. Recurrence data collection should be completed in 2015.
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