Having completed 2 years of surgical residency training in urology at the University of Toronto, I enrolled in the Masters of Public Health (MPH) program in Public Health Leadership at the University of North Carolina at Chapel Hill (UNC-CH). I chose this path to gain the knowledge and skills to approach health problems from both the population perspective as well as the individual patient perspective. I have felt for some time that such a strategy is key to helping African American men (AAM) with prostate cancer as the incidence and mortality is the highest of any ethnic group in the world. The reasons for this disparity appear to involve multiple factors and as such approaching this problem from a population perspective may prove the only way to reduce the disparity.

I am currently one year into my program at UNC-CH. With much of my didactic learning complete, I feel the Health Disparity Training - Prostate Scholar Award would come at an ideal time as I transition into research for the next two years.

Ultimately, I plan to finish residency, complete a fellowship in urologic oncology in the United States, and then practice as an academic urologist with a focus in urologic oncology and in particular, prostate cancer. With this multidisciplinary training, I plan on being not only a culturally competent surgeon, but one with particular ability to advocate for minority groups and address issues of racial disparity as they pertain to prostate cancer. I plan to continue research in this field throughout my career and be highly involved in teaching medical students, residents and fellows.

The 2-year program I propose will include a large research component and an interactive learning component involving coursework, seminars, journal clubs, and conferences. The program will be under the co-supervision of Drs. Judd Moul and Stephen Freedland at Duke University. Both have extensive experience and publications in the field of prostate cancer racial disparity and are leaders in their field in this regard.

The research project I propose is to examine the association between statins and improved outcomes after surgery for prostate cancer. Statins are a class of drug designed originally to lower cholesterol and reduce death from cardiovascular events. We have good evidence that statins accomplish this goal. However, recently, evidence is building to show that statins also have the ability to reduce the risk of getting cancer or the progression of cancer to aggressive forms. Prostate cancer is no exception. A recent study showed that statin use was associated with a 46% reduction in aggressive prostate cancer and a 66% reduction in fatal prostate cancer. Statins are particularly appealing as they would not only improve health outcomes related to the cancer itself, but we know they would also improve overall survival by reducing cardiovascular events like heart attacks.

The most exciting aspect of this is that we have good reason to believe that the effects of statins on prostate cancer patients may be most pronounced in African American men. We know that the genetic make-up of the prostate and factors that drive prostate cancer production are different in African American men. Early evidence suggests that statins may target these specific differences and thus provide significant advantages to African American men with prostate cancer.

We will study this phenomenon in an already established database of men who have undergone surgery (radical prostatectomy) for their prostate cancer. The Shared Equal Access Regional Cancer Hospital (SEARCH) database has 2,200 men, with 27% of African American ethnicity. Using computerized records to determine who has taken statins and for how long, we can correlate this with a marker for cancer recurrence: the reappearance of PSA after surgery.

It is anticipated that we will gain a far better understanding of the association between statins and prostate cancer biology. In particular, we will glean vital information regarding this association in African American men, the population that stands to gain the most. Should statins prove to be associated with improved outcomes, we foresee conducting a prospective randomized, controlled trial to test whether statin use could delay cancer recurrence after treatment, particularly in high-risk African American men. As evidence builds, we may, some day, recommend that all men be placed on statins in order to reduce the risk of even getting prostate cancer. The appeal of a drug with both prostate cancer and cardiovascular benefits for African American men could profoundly narrow the gap in prostate cancer outcomes between African American men and other ethnic groups.

In summary, there is great potential for synergistic benefit with our proposed project. First, the training program under the mentorship of Drs. Judd Moul and Stephen Freedland will provide an excellent foundation to launch my career in prostate cancer health disparities research. Secondly, the project I propose as part of the training program has the potential to address a crucial disparity among African American men with prostate cancer. This project could prove to be of marquis importance as statins move toward becoming the prostate cancer chemopreventive agent.