Ethnic Variation in Pelvimetric Measures and Its Impact on Positive Surgical Margins at Radical Prostatectomy

Bodman, Christian J. von; Matikainen, Mika; Yunis, Luis Herran; Laudone, Vincent P.; Scardino, Peter T.; Akın, Oğuz; Rabbani, Farhang

doi:10.1016/j.urology.2010.02.020

Cited by 32 publications

(32 citation statements)

References 18 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…24,25 Variations in pelvic anatomy between AA and Caucasian men, including steeper symphysis pubis angles and more narrow mid pelvic areas in AA men, have been described that may impart a greater technical challenge, particularly during apical dissection. 26,27 …”

Section: Discussionmentioning

confidence: 99%

Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy

et al. 2016

View full text Add to dashboard Cite

Purpose Racial disparities in the incidence and risk profile of prostate cancer at diagnosis among African-American men are well reported. However, it remains unclear whether African-American race is independently associated with adverse outcomes in men with clinical low risk disease. Materials and Methods We retrospectively analyzed the records of 895 men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database in whom clinical low risk prostate cancer was treated with radical prostatectomy. Associations of African-American and Caucasian race with pathological biochemical recurrence outcomes were examined using chi-square, logistic regression, log rank and Cox proportional hazards analyses. Results We identified 355 African-American and 540 Caucasian men with low risk tumors in the SEARCH cohort who were followed a median of 6.3 years. Following adjustment for relevant covariates African-American race was not significantly associated with pathological upgrading (OR 1.33, p = 0.12), major upgrading (OR 0.58, p = 0.10), up-staging (OR 1.09, p = 0.73) or positive surgical margins (OR 1.04, p = 0.81). Five-year recurrence-free survival rates were 73.4% in African-American men and 78.4% in Caucasian men (log rank p = 0.18). In a Cox proportional hazards analysis model African-American race was not significantly associated with biochemical recurrence (HR 1.11, p = 0.52). Conclusions In a cohort of patients at clinical low risk who were treated with prostatectomy in an equal access health system with a high representation of African-American men we observed no significant differences in the rates of pathological upgrading, up-staging or biochemical recurrence. These data support continued use of active surveillance in African-American men. Upgrading and up-staging remain concerning possibilities for all men regardless of race.

show abstract

Section: Discussionmentioning

confidence: 99%

Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…What explains the relationship between AA race and risk of PSM is unclear. However, anatomic pelvic variations are believed to increase the risk of PSM during RP in AA men due to steeper symphysis pubis angles and smaller midpelvis areas in AA men compared with Caucasian men [31]. In this situation, the risk of apical PSM is higher.…”

Section: Discussionmentioning

confidence: 99%

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

et al. 2015

View full text Add to dashboard Cite

Background: African American (AA) men suffer a higher prostate cancer (PCa) burden than other groups. Objective: We aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance. Design, setting, and participants: We studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site. Results and limitations: Of 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n = 273; 6.5%), Caucasian (n = 3771; 89.1%), or other racial/ethnic group (Other; n = 187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: AE7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups ( p < 0.01). We found an association between race group and PSM rate ( p < 0.03), with higher odds of PSMs in AA men versus Caucasian men (odds ratio [OR]: 1.64; 95% confidence interval [CI], 1.08-2.47). No statistically significant associations between race and rates of upgrading and upstaging were found. This study was limited by the relatively low proportion of AA men in the cohort. Conclusions: Among clinically low-risk men who underwent RP, AA men had a higher likelihood of PSMs compared with Caucasian men. We did not find statistically significantly different rates of upgrading and upstaging between the race groups. Patient summary: We analyzed two large groups of men with what appeared to be lowrisk prostate cancer based on the initial biopsy findings. The likelihood of finding worse disease (higher grade or stage) at the time of surgery was similar across different racial groups.

show abstract

“…Although surgeon proficiency is a technical factor in margin status, other factors including obesity and variations in pelvic anatomy have been postulated to contribute to racial differences in margin status at RP. 19,20 Increased rates of positive margins are important outcomes to consider in the AA patient as they may require the need for adjuvant radiation to reduce the risk of BCR and progression. 21 It is known that PSM rates are associated with higher risks of BCR in AA men after RP.…”

Section: Commentmentioning

confidence: 99%

Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

Faisal

Sundi

Cooper

et al. 2014

Urology

View full text Add to dashboard Cite

OBJECTIVE To report race-based outcomes after radical prostatectomy (RP) in a cohort stratified by National Comprehensive Cancer Network (NCCN) risk category with updated follow-up. MATERIALS AND METHODS Studies describing racial disparities in outcomes after RP are conflicting. We studied 15,993 white and 1634 African American (AA) pretreatment-naïve men who underwent RP at our institution (1992–2013) with complete preoperative and pathologic data. Pathologic outcomes were compared between races using appropriate statistical tests; biochemical recurrence (BCR) for men with complete follow-up was compared using multivariate models that controlled separately for preoperative and postoperative covariates. RESULTS Very low- and low-risk AA men were more likely to have positive surgical margins (P <.01), adverse pathologic features (P <.01), and be upgraded at RP (P <.01). With a median follow-up of 4.0 years after RP, AA race was an independent predictor of BCR among NCCN low-risk (HR, 2.16; P <.001) and intermediate-risk (hazard ratio [HR], 1.34; P = .024) classes and pathologic Gleason score ≤6 (HR, 2.42; P <.001) and Gleason score 7 (HR, 1.71; P <.001). BCR-free survival for very low-risk AA men was similar to low-risk white men (P = .890); BCR-free survival for low-risk AA men was similar to intermediate-risk white men (P = .060). CONCLUSION When stratified by NCCN risk, AA men with very low-, low-, or intermediate-risk prostate cancer who undergo RP are more likely to have adverse pathologic findings and BCR compared with white men. AA men with “low risk” prostate cancer, especially those considering active surveillance, should be counseled that their recurrence risks can resemble those of whites in higher risk categories.

show abstract

Ethnic Variation in Pelvimetric Measures and Its Impact on Positive Surgical Margins at Radical Prostatectomy

Cited by 32 publications

References 18 publications

Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy

Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

Contact Info

Product

Resources

About