The objective of this application is to seek support for a conference on """"""""Prostate Cancer Disparity: Science, Health Care, and Public Policy."""""""" The conference will address the science and health care of prostate cancer as a public health issue within the African American Community with a special emphasis on Washington DC. Prostate cancer does not affect everyone equally, but imposes a heavier burden on African American men (AAM). In AAM, the disease is more common, has an earlier age of onset, and tends to be more aggressive than in Caucasian men. The conference will address the significance of earlier onset and aggressive behavior and the implications for screening, early diagnosis, staging, treatment and health care delivery. Clinical studies have clearly shown that AAM have more advanced cancers at diagnosis and reduced survival rates compared with Caucasian men. The conference will also address current prevention research and whether the research results will apply to AAM considering the differences in disease presentation. While the disparity has been investigated concerning social economic status and other demographic factors, the origin and significance of the aggressive disease in relation to survival disadvantage and public policies have not been fully addressed. Reasons for these racial differences will be explicitly explored through risk factor analysis, epidemiological reviews, molecular genetic factors, and current public policies in early detection and treatment. Moreover, lessons learned in the military about the prostate cancer diagnosis, treatment and clinical trial participation will be considered in relation to the civilian population. An important objective for the conference will be a consideration of the clinical implications of aggressive disease and whether the current recommendations for screening, staging, and health care should be modified for specific racial/ethnic groups based on a consideration of the potential causative factors, biological behavior, and access to care. An important issue relating to the disparity is education not only in diagnosis but also in treatment. Through a special session, conference participants will review current public policies to determine whether these policies are addressing the disparity in a satisfactory manner. Specifically, the costs, benefits, and access to screening in different populations will be considered within the disparity. Conclusions and recommendations from the conference designed to reduce the disparity will be published. The conference is planned of September, 21-22, 2004 in Washington, DC.
