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Active surveillance appears unsuitable for black men with prostate cancer
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Black men with low-risk prostate cancer who met the criteria for active surveillance but underwent radical prostatectomy experienced significantly higher rates of upgrading and adverse pathology than white men and those of other races, according to study results.
Previous studies have established active surveillance as a viable treatment option for men with very low-risk prostate cancer, but positive outcomes in active surveillance studies often are based on cohorts with an underrepresented black demographic.
Edward M. Schaeffer
“The criteria physicians use to define very low-risk prostate cancer works well in whites — this makes sense, since the studies used to validate the commonly used risk classification systems are largely based on white men,” Edward M. Schaeffer, MD, PhD, associate professor of urology, oncology and pathology at Johns Hopkins University School of Medicine, said in a press release. “[However] among the vast majority of African-American males with very-low-risk cancer who underwent surgical removal of the prostate, we discovered that they face an entirely different set of risks.”
To assess whether race-based health disparities exist among men with very low-risk prostate cancer, Schaeffer and colleagues retrospectively analyzed 1,801 patients who met National Comprehensive Cancer Network criteria for very low-risk prostate cancer and had undergone radical prostatectomy.
Schaeffer and colleagues compared presenting characteristics, pathologic data and cancer recurrence among whites (n=1,473), blacks (n=256) and other races (n=72). The researchers also performed multivariable modeling to determine the association of race with upgrading and adverse pathologic features.
According to study results, black men exhibited more adverse pathologic features at radical prostatectomy and poorer oncologic outcomes.
The researchers observed that black men were more likely to experience disease upgrading at prostatectomy (27.3% vs.14.4%; P<.001), positive surgical margins (9.8% vs. 5.9%; P=.02) and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system scores.
Multivariable analysis showed black race was found to be an independent predictor of adverse pathologic features (OR=3.23; P=.03) and pathologic upgrading (OR=2.26; P=.03).
“This study offers the most conclusive evidence to date that broad application of active surveillance recommendations may not be suitable for African-Americans,” Schaeffer said. “This is critical information because if African-American men do have more aggressive cancers, as statistics would suggest, then simply monitoring even small cancers that are very low risk would not be a good idea because aggressive cancers are less likely to be cured.”
Comprehensive analysis showed that black men, when compared with whites, exhibited a lower rate of organ-confined cancers (87.9% vs. 91.0%), a higher rate of Gleason score upgrading (27.3% vs. 14.4%) and a significantly higher hazard of PSA-defined biochemical recurrence of prostate cancer.
“The results of our study do not support the universal rejection of [active surveillance] in black men but, rather, should promote future studies to address whether alternate race-specific surveillance entry criteria should be used for African-American men to ensure oncologic parity with their white counterparts,” Schaeffer said.
Disclosure: The researchers report no relevant financial disclosures.
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