Association of Prostate-Specific Antigen Velocity With Clinical Progression Among African American and Non-Hispanic White Men Treated for Low-Risk Prostate Cancer With Active Surveillance

Abstract

IMPORTANCEThe association of prostate-specific antigen velocity (PSAV) with clinical progression in patients with localized prostate cancer managed with active surveillance remains unclear and, to our knowledge, has not been studied in African American patients.OBJECTIVES To test the hypothesis that PSAV is associated with clinical progression in patients with low-risk prostate cancer treated with active surveillance and to identify differences between African American and non-Hispanic White patients. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective population-based cohort study using patient records from the Veterans Heath Administration Informatics and Computing Infrastructure on 5296 patients with a diagnosis of localized prostate cancer from January 1, 2001, to December 31, 2015, who were managed with active surveillance. Follow-up extended through March 31, 2020. Low-risk prostate cancer was defined as International Society of Urologic Pathology grade group (GG) 1 clinical tumor stage 2A or lower, PSA level of 10 ng/dL or lower, active surveillance, and no definitive treatment within the first year after diagnosis with at least 1 additional staging biopsy after diagnostic biopsy. EXPOSURES Prostate-specific antigen testing. MAIN OUTCOMES AND MEASURESThe primary outcome was GG progression detected after repeated biopsy or prostatectomy, defined as GG2 or higher or GG3 or higher. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards regression models were used to test associations between PSAV and outcomes. RESULTSThe final cohort (n = 5296) included 3919 non-Hispanic White men (74.0%; mean [SD] age, 65.7 [5.8] years) and 1377 African American men (26.0%; mean [SD] age, 62.8 [6.6] years). Compared with African American patients, non-Hispanic White patients were older (mean [SD] age, 65.7 [5.8] years vs 62.8 [6.6] years; P < .001), presented with higher cT stage (stage T2, 608 [15.5%] vs 111 [8.1%]; P < .001), had a higher Charlson Comorbidity Index score (1 and Ն2, 912 [23.3%] vs 273

Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE)

“…Hence, those subjects deserve particular attention during TRT. The PSA velocity, previously considered a marker for TRT withdrawn and prostate biopsy, has been criticized [174,175]. Accordingly, the European Association of Urology guidelines suggest that PSA density (PSAD) with a Prostate Imaging Reporting and Data System (PI-RADS) score (≥ 3) might help in decision for further evaluations [173].…”

Risk Stratification of Low-risk Prostate Cancer: Individualizing Care in the Era of Active Surveillance

“…The 1,400 Black men in this study experienced increased risk of upgrading (but not metastasis) at lower PSA velocities than their White counterparts. 34…”

“…The 1,400 Black men in this study experienced increased risk of upgrading (but not metastasis) at lower PSA velocities than their White counterparts. 34 PSA density is a measure that normalizes PSA levels to prostate volume, eliminating the variability introduced by prostate size. There is abundant evidence PSA density is associated with increased risk of upgrading and reclassification while on AS, 8,11 and that it outperforms base PSA in predicting these events.…”

Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care

“…Policy and guideline recommendations regarding diagnostic and therapeutic interventions are driven by the availability and quality of trial data, and the lack of available evidence hinders developing recommendation for the early detection of prostate cancer in Black men around the world, though NCCN has attempted to do so for sub-Saharan Africa [90]. PSA and PSA derivatives (i.e., PSA density) may vary by race/ethnicity [91,92]. Studies have demonstrated Black men undergoing prostate cancer screening have higher PSA levels [93] and more rapid increases in PSA [94] compared with men of other race/ethnicities, which could be due to biological, social or lifestyle factors, or access to care.…”