Impact of race on survival in patients with clinically nonmetastatic prostate cancer who deferred primary treatment

Abstract

BACKGROUND Prostate cancer (PCa) racial disparity studies typically focus on survival differences after curative treatment. The authors of this report hypothesized that comparing mortality rates between African American (AA) and Caucasian American (CA) patients who deferred primary treatment for clinically nonmetastatic PCa may provide a better assessment of the impact of race on the natural course of PCa. METHODS The pathology database of the New York Veterans Administration Medical Center (VAMC), an equal access-of-care facility, was searched for patients with biopsy-proven PCa. Inclusion criteria included 1) no evidence of metastatic disease or death within 3 years after diagnosis, 2) no primary treatment, and 3) a minimum of 5 years of follow-up for survivors. RESULTS In total, 518 patients met inclusion criteria between 1990 and 2005. AA patients were younger (P=.02) and had higher median prostate-specific antigen (PSA) levels (P=.001) at the time of diagnosis compared with CA patients. In a multivariate model, higher Gleason score and PSA level were associated with increased mortality (P=.001 and P=.03, respectively), but race was not a predictor of death from PCa. CONCLUSIONS The current data suggested that race did not have a major impact on survival in patients with PCa who deferred primary treatment for clinically nonmetastatic disease.

Rethinking active surveillance for prostate cancer in African American men

“…The cohort examined by Cullen et al defined AS as the absence of treatment for a minimum of 9 months after prostate cancer diagnosis ( 73 ). Similarly, in the cohort presented by Koscuiszka et al , the majority of the patients had intermediate- or high-risk disease, and primary use of androgen deprivation was included within the definition of a deferred primary treatment ( 74 ). Both of these are more consistent with a deferred primary treatment rather than an AS cohort.…”

Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer

“…However, most studies supporting these claims were unable to adjust for significant predictors of survival, and were subject to many unmeasured confounders which may have affected oncological outcomes. 41,42 Indeed, by excluding men who refused/were not offered surgical treatment for PCa, we are selecting a cohort of individuals of Black men who may be more directly comparable to nHWs than in previous studies, as they were deemed ‘fit’ for surgery. In those who make it to the operating table, despite poorer surgical quality of care as elucidated above, their survival rates were equivalent.…”

Race is associated with discontinuation of active surveillance of low-risk prostate cancer: Results from the Duke Prostate Center

“…al. 28 , again found no difference in overall survival between black and white men undergoing watchful waiting. The authors highlight that competing causes of death are more common than death from PC, especially in their cohort in which the median age at PC diagnosis was 73 years.…”

“…To our knowledge two studies have examined the effect of race on overall survival for men undergoing expectant management for PC. 27,28 In their analysis of the Center for Prostate Disease Research database, Cullen et. al.…”

“…There have been two studies analyzing the effect of race on overall mortality in men undergoing delayed PC therapy or watchful waiting, with neither finding a significant difference. 27,28 A recent analysis has shown, however, that race is a predictor of biopsy progression on AS. 29 We hypothesize that black men have more aggressive PC that are more likely to progress on AS, and are therefore more likely to proceed to treatment faster than white men.…”