It is an honor to gain the support of the AUA through the Summer Medical Student Fellowship program to study genetic prostate cancer markers for their role in screening for any patient, regardless of background.

As our understanding of prostate cancer genetics and genomics has developed, an era of precision oncology approaches to early detection and treatment is emerging. However, despite these advances, prostate cancer is still the second leading cause of cancer-related death among men in the United States, accounting for an estimated 268,490 new cases and 34,500 deaths in 2022.¹

Although a patient’s genetic makeup explains an estimated 57% of variability in prostate cancer risk, national screening guidelines currently do not incorporate genetic risk into recommended screening strategies. Furthermore, the risk of prostate cancer is variable across populations. For example, Black individuals carry the highest prostate cancer incidence and mortality in the United States.¹ Given the demonstrated heritable component of prostate cancer through family history and transmissible variants, screening tools that individualize a patient’s genetic risk for prostate cancer (ie, polygenic risk scores) have enormous potential to reduce morbidity by enabling precision medicine approaches to early detection and intervention. Unfortunately, most prior genome-wide association studies that identified genetic markers of risk were largely performed on cohorts that lacked representation of individuals from non-European ancestries, limiting their equitable application to our diverse patient populations at large.^2-4 However, for ethical implementation of precision medicine guided population screening tools, their development requires use of cohorts with adequate representation across ancestral groups to yield equitable benefit among all patients.

Health inequities in prostate cancer have enormous impact on timely diagnosis and treatment, and there are well-established differences in incidence and mortality of prostate cancer across patient populations historically underrepresented in biomedical research.^5-7 Similarly, family history is a well-established risk factor for prostate cancer but also encompasses shared environmental exposures, and its impact on prostate cancer risk may vary across patient populations. To address these questions, we seek to evaluate the performance of a state-of-the-art polygenic hazard score using diverse genomic data collected by the National Institutes of Health and Mass General Brigham Biobank. In doing so, we hope to elucidate how to improve such polygenic risk scores so they may benefit any patient. In addition, I hope that this work will bring attention to the utility of genomic markers to enhance screening for malignancy in general. This awareness is essential to exact legislative change to enhance accessibility to genetic testing as recommended by contemporary cancer diagnosis guidelines, but with limited covered by medical insurance, including Medicare.

As an aspiring physician-scientist in urologic oncology, my dream is to improve performance of modern genetic risk scores in all individuals, regardless of race or ancestry. The support of the AUA and Urology Care Foundation™ has afforded me the resources to access and utilize genomic data from the National Institutes of Health to complete this work. Further, I am grateful for the support from Harvard Medical School and mentorship provided by Dr Keyan Salari, director of the Prostate Cancer Genetics Program at Massachusetts General Hospital. I am honored to have the generosity and support of the AUA Summer Medical Student Fellowship Program to help catalyze translation of modern genetic risk markers from the lab bench to the clinic.