Leanne Woods-Burnham Laura Stiel Shannalee R. Martinez Evelyn S. Sanchez-Hernandez Herbert C. Ruckle Frankis G. Almaguel Mariana C. Stern Lisa R. Roberts David R. Williams Susanne Montgomery Carlos A. Casiano


Recent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in African American (AA) men and other men of African Ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling.  This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR—together with specific genetic drivers—may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities.  Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators, both agonists and antagonists, should increase the participation of AA patients and carefully assess racial differences in therapy response and clinical outcomes.