Clinical and Demographic Characteristics Associated With Prostate Cancer Progression in Patients on Active Surveillance

Iremashvili, Viacheslav; Soloway, Mark S.; Rosenberg, Daniel L.; Manoharan, Murugesan

doi:10.1016/j.juro.2011.12.082

Cited by 90 publications

(89 citation statements)

References 20 publications

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“…5 Because AA men have a higher age-adjusted prostate cancer incidence (1.6 times) and poorer oncologic outcomes following primary treatment, 6 it is imperative to determine the pathologic and oncologic outcomes of AA men with very low-risk prostate cancer to assess their suitability for active surveillance.…”

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

“…7 In contrast, another study of 24 very low-risk AA men (clinical stage, Յ T2a; Gleason sum, Յ 6; positive cores, Յ 2; cancer involvement per core, Յ 20%) who are part of the active surveillance cohort at the University of Miami found that patients whose disease progressed by grade or volume were more likely to be AA and that AA race was an independent predictor of disease progression on active surveillance. 5 The factors that result in these divergent observations are unclear and may be influenced by the limited sample sizes used in these analyses.…”

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

See 1 more Smart Citation

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?

Sundi

Ross

Humphreys

et al. 2013

JCO

213

171

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A B S T R A C T PurposeActive surveillance (AS) is a treatment option for men with very low-risk prostate cancer (PCa); however, favorable outcomes achieved for men in AS are based on cohorts that under-represent African American (AA) men. To explore whether race-based health disparities exist among men with very low-risk PCa, we evaluated oncologic outcomes of AA men with very low-risk PCa who were candidates for AS but elected to undergo radical prostatectomy (RP). Patients and MethodsWe studied 1,801 men (256 AA, 1,473 white men, and 72 others) who met National Comprehensive Cancer Network criteria for very low-risk PCa and underwent RP. Presenting characteristics, pathologic data, and cancer recurrence were compared among the groups. Multivariable modeling was performed to assess the association of race with upgrading and adverse pathologic features. ResultsAA men with very low-risk PCa had more adverse pathologic features at RP and poorer oncologic outcomes. AA men were more likely to experience disease upgrading at prostatectomy (27.3% v 14.4%; P Ͻ .001), positive surgical margins (9.8% v 5.9%; P ϭ .02), and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system (CAPRA-S) scores. On multivariable analysis, AA race was an independent predictor of adverse pathologic features (odds ratio, [OR], 3.23; P ϭ .03) and pathologic upgrading (OR, 2.26; P ϭ .03). ConclusionAA men with very low-risk PCa who meet criteria for AS but undergo immediate surgery experience significantly higher rates of upgrading and adverse pathology than do white men and men of other races. AA men with very low-risk PCa should be counseled about increased oncologic risk when deciding among their disease management options.

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Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

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?

Sundi

Ross

Humphreys

et al. 2013

JCO

213

171

View full text Add to dashboard Cite

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“…However, evidence for the benefit of AS was based on studies conducted in primarily CS cohorts [24,25]. In studies where race was reported, 5% to 10% of patients enrolled in AS program were AA men [20,26]. One retrospective study evaluated the effect of race on discontinuation of AS for patients with low-risk PCa.…”

Section: Discussionmentioning

confidence: 99%

Novel Nomogram That Predicts Aggressive Disease and Treatment Failure Among African-American Men with Prostate Cancer

Yamoah¹

2014

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“…Iremashvili et al 15 reported a significantly higher progression risk in black patients with PCa on AS when compared to white patients. During a median follow-up of 2.9 years with a mean of 2.3 surveillance biopsies, the risk of progression was significantly higher in AA men (hazard ratio 3.87-4.12).…”

Section: Commentsmentioning

confidence: 99%

“…[9][10][11][12] Because AA men tend to have a more aggressive disease at diagnosis compared to WA men, 13,14 it is unclear whether the same AS criteria should be applied to AA men. For example, Iremashvili et al 15 recently reported that AA patients on AS have a significantly higher risk of progression than their WA counterparts. In contrast, Cullen et al 16 reported that there was no racial disparity in overall survival among the AS cohort.…”

mentioning

confidence: 99%

226 Increased Incidence of Pathologically Non-Organ Confined Prostate Cancer in African-American Men Eligible for Active Surveillance

Salmasi

Kim

et al. 2013

Journal of Urology

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OBJECTIVE-To compare the clinicopathologic findings of African-American (AA) and WhiteAmerican (WA) men with prostate cancer (PCa) who were candidates for active surveillance (AS) and underwent radical prostatectomy (RP).METHODS-Prospectively maintained database of men who underwent RP from 2 academic centers were analyzed retrospectively. Postoperative pathologic characteristics of patients who met the AS inclusion criteria of the University of California, San Francisco (UCSF) and National Comprehensive Cancer Network (NCCN) were evaluated. After RP, the rate of pathological upstaging and Gleason upgrading were compared between AA and WA men.RESULTS-In the AA cohort, 196 and 124 men met the UCSF and NCCN criteria for AS, respectively. With respect to WA patients, 191 and 148 fulfilled the AS criteria for UCSF and NCCN, respectively. AA men had a higher percentage of maximum biopsy core than WA men (15.3%-20.4% vs 11.5%-15.0%, P <.05, respectively) in both cohorts. In addition, a greater proportion of AA men had multiple positive biopsy cores compared to WA men (45.2% vs 33.1%, P = .046) under the NCCN criteria. A higher proportion of AA men were upstaged (≥pT3) compared to WA men (19.4% vs 10.1%, P = .037). A multivariate regression test revealed that age, preoperative PSA, and number of positive cores were independent predictors of more advanced disease (upstaging and/or upgrading) in AA men.CONCLUSION-AA men who were candidates for AS criteria had worse clinicopathological features on final surgical pathology thanWA men. These results suggest that a more stringent AS criteria should be considered in AA men with prostate cancer.African-American (AA) men have a relatively higher risk of developing prostate cancer (PCa) and dying of PCa compared to White-American (WA) men. 1-4 Between 2004 and2008, in the United States, the annual PCa incidence and mortality rates for AA men were 230.8 and 54.9 (per 100,000), respectively; whereas the respective rates for WA men were 142.8 and 22.4 (per 100, 000), respectively. 5 Although the precise reason for this racial disparity is uncertain, higher tumor grade at initial diagnosis, more aggressive tumor behavior, and poorer access to care in AA men have been suggested to contribute to these differences. 1,3,6,7 Active surveillance (AS) is an acceptable treatment option for men with low risk PCa. However, there is reluctance among health care providers and patients in accepting AS as a viable treatment option for PCa because of the inaccuracy of clinical staging. 8 In this regard, it has been reported that in men who are eligible for AS, the risk of nonorgan-confined disease (pathological upstaging) at radical prostatectomy (RP) ranges from 5%-13.7%. [9][10][11][12] Because AA men tend to have a more aggressive disease at diagnosis compared to WA men, 13,14 it is unclear whether the same AS criteria should be applied to AA men. For example, Iremashvili et al 15 recently reported that AA patients on AS have a significantly higher risk of progression than their WA coun...

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Clinical and Demographic Characteristics Associated With Prostate Cancer Progression in Patients on Active Surveillance

Cited by 90 publications

References 20 publications

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?

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?

Novel Nomogram That Predicts Aggressive Disease and Treatment Failure Among African-American Men with Prostate Cancer

226 Increased Incidence of Pathologically Non-Organ Confined Prostate Cancer in African-American Men Eligible for Active Surveillance

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