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Observational Study
. 2020 Dec;23(4):581-588.
doi: 10.1038/s41391-020-0230-6. Epub 2020 Apr 23.

African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance

Rishi Deka  1   2 , J Kellogg Parsons  3 , Daniel R Simpson  4   5 , Paul Riviere  4   5 , Vinit Nalawade  4   5 , Lucas K Vitzthum  4   5 , A Karim Kader  3 , Christopher J Kane  3 , Chelsea S Rock  4   5 , James D Murphy  4   5 , Brent S Rose  4   5   3
Affiliations
Observational Study

African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance

Rishi Deka et al. Prostate Cancer Prostatic Dis. 2020 Dec.

Abstract

Background: There is concern that African-American men (AA) with low-risk prostate cancer may present with more aggressive disease and thus may not be candidates for active surveillance (AS). However, it is uncertain if poorer outcomes are due to disparities in access to medical care rather than true biological differences.

Methods: Observational cohort study of patients diagnosed with low-risk PC-Gleason score ≤6, clinical tumor stage ≤2A, and prostate specific antigen (PSA) level ≤10-at US Department of Veterans Affairs between January 1, 2001 and October 31, 2015 and treated with radical prostatectomy. Outcomes included upgrading to Gleason Grade Group 2 (GG2), GG ≥ 3, PSA recurrence, pathologic tumor stage ≥3, positive surgical margins, and all-cause mortality.

Results: A total of 2857 men (AA: 835 White: 2022) with a median follow-up of 7.1 years. Overall, there was no significant difference between AA and White men in upgrading to GG ≥ 3 (RR = 1.18, p = 0.43), tumor stage ≥3 (RR = 0.95, p = 0.74), positive surgical margins (RR = 1.14, p = 0.20), PSA recurrence (SHR = 1.26, p = 0.06), and all-cause mortality (SHR = 1.26, p = 0.16). However, there was a significant increase in upgrading for AA to GG2 (RR = 1.49, p < 0.01).

Conclusions: There was no significant difference in most adverse pathologic outcomes between AA and White patients. However, GG2 upgrading was more common in AA men. The implication is that AA may need to undergo additional evaluation, such as a biopsy MRI, before initiating AS. Whether the increase in GG2 upgrading will lead to poorer long-term clinical outcomes such as metastasis and PCSM also requires further investigation.

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References

    1. Sundi D, Ross AE, Humphreys EB, Han M, Partin AW, Carter HB, et al. African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them? J Clin Oncol. 2013;31:2991–7. - DOI
    1. Sundi D, Schaeffer EM. Active surveillance for African-American men with prostate cancer: proceed with caution. Con Oncol. 2014;28:85.
    1. Moul JW. Active surveillance for African-American men with prostate cancer: of course! Pro. Oncology. 2014;28:84–5.
    1. Mahal BA, Alshalalfa M, Spratt DE, Davicioni E, Zhao SG, Feng FY, et al. Prostate cancer genomic-risk differences between African-American and White Men across Gleason Scores. Eur Urol. 2019;75:1038–40.
    1. Mahal BA, Berman RA, Taplin ME, Huang FW. Prostate cancer-specific mortality across Gleason scores in black vs. non-black men. JAMA 2018;320:2479–81. - DOI

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