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Watchful waiting may not benefit black men with low-grade prostate cancer
In patients with low-grade prostate cancer, black race was associated with poorer outcomes in terms of freedom from biochemical failure after radical prostatectomy, according to recent findings.
These findings suggest that for some patients in this population, more aggressive treatments may be preferable to the “watchful waiting” approach currently recommended for low-grade cases, the researchers wrote.
In the retrospective study, researchers evaluated the medical records of 1,265 men with low-grade prostate cancer who underwent radical prostatectomy at the University of Pennsylvania Health System between 1990 and 2012. Among the study patients, 234 were black and 1,031 were white.
Besides undergoing radical prostatectomy, eligible patients met the following criteria for low- to intermediate-risk prostate cancer: Gleason score (GS) ≤ 7(3+4) T stage ≤ T2c, and PSA ≤ 20 ng/mL.
The researchers first evaluated the entire cohort for associations between clinical factors and poor pathologic outcomes and freedom from biochemical failure (FFbF), then performed a subgroup analysis of 705 patients (112 blacks and 593 whites) who had pathologic GS r6, or low-grade disease. In this cohort, they assessed the role played by race in FFbF along with low-grade disease confirmed by radical prostatectomy and similar CAPRA-S scores. The median follow-up was 27 months.
Kosj Yamoah
The researchers found that in the overall cohort, the 7-year FFbF rate was 86% in white men vs. 79% in black men (P=.035). No significant disparity was seen between the two races in one or more adverse pathologic characteristics (27% in whites vs. 31% in whites; P=.035). Moreover, no significant difference was seen between the races in CAPRA-S scores (P=.28).
The subset analysis revealed that in low-grade patients, black patients had worse FFbF at 7 years (P=.002). Moreover, black race was found to be significantly predictive of FFbF in men with low-grade prostate cancer (HR=2.01; 95% CI, 1.08-3.72).
According to researcher Kosj Yamoah, MD, chief resident in the department of radiation oncology at Thomas Jefferson University, prospective studies are needed to determine whether black patients with prostate cancer who have low Gleason scores should undergo a more aggressive treatment strategy.
“We know that African American men have more aggressive prostate cancer than Caucasian men,” Yamoah said in a press release. “Our study shows that African American men who are diagnosed with a low-grade cancer at first — the cancers that are sometimes watched rather than treated — are more likely to develop aggressive much sooner than Caucasian men.”
Disclosure: The researchers report no relevant financial disclosure.
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