Abstract C72: Improving the accuracy and diagnostic power of prostate biopsy for African American patients: The Birmingham Alabama Prostate Cancer (BAPrCa) Consortium

Study Purpose: Both incidence and mortality data show that the burden of prostate cancer (PrCa) is greater in African Americans (AA) than in European Americans (EA). Socioeconomic factors contribute to this health disparity, but do not fully account for observations that AA are more likely than others to be diagnosed with more aggressive and life threatening forms of PrCa. Prostate biopsies usually establish the diagnosis of PrCa and are used to estimate the extent of the disease (based on the number and location of cores with cancer and involvement of individual cores) and its potential aggressiveness (based on Gleason scores). Health policy groups recommend that men with limited low grade prostate cancer be managed by active surveillance (AS) rather than immediate surgical or radiation treatment. However, the standard-of-care prostate biopsy is limited by sampling error and the possibility that a high grade PrCa might have been missed is a significant concern for many patients who are considering AS; this concern is heightened for AA because of their higher risk of aggressive disease. Moreover, AA are more likely to be diagnosed with high grade/high stage prostate cancer that is not treated surgically and thus not well represented in molecular studies that utilize radical prostatectomy specimens. Our research team established the Birmingham Alabama Prostate Cancer (BAPrCa) Consortium with a major focus on the molecular analysis of prostate biopsies in order to increase the clinically actionable information that can be obtained from these specimens. We use an ancestry-informed approach that is specifically designed to improve the accuracy and diagnostic power of prostate biopsy for AA patients. Experimental Procedures: The BAPrCa Consortium implemented an innovative prostate biopsy “tissue print” technology that permits collection of snap-frozen nitrocellulose blots of biopsy cores without diagnostically compromising these specimens. Tissue prints provide high quality RNA and DNA from biopsies from the full range of patients, including AAs whose cancer is too advanced at diagnosis for radical prostatectomy; this permits the molecular characterization of PrCa subtypes in men diagnosed with high volume/high grade disease who have not been adequately represented in previous molecular profiling studies. Our BAPrCa research protocols include informed consent for genetic ancestry admixture studies. Gene expression analysis of prostate biopsy tissue prints is co