Multi-institution analysis of racial disparity among African-American men eligible for prostate cancer active surveillance

Abstract

There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African-American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003–2014 were used to assess potential racial disparity. Of the 333 (14.8%) African-American and 1923 (85.2%) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p < 0.01), pre-op PSA (5.2 v 4.7; p < 0.01), and maximum percentage cancer on biopsy (15.1% v 13.6%; p < 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed.

Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer

“…In this study, the AA race was a significant predictor of pathological upgrading and upstaging (OR 1.2, 95% CI 1.1-1.3, p < 0.01). Despite these findings, other studies have not found a significant association between black race and pathological upgrading or upstaging [13,[19][20][21]. A major limitation of these studies is underrepresentation of AA men with the largest study including 355 AA men.…”

Recognizing and minimizing bias: Helping patients make their best choice for prostate cancer management through multidisciplinary clinics

“…Longstanding dogma based on epidemiologic data has posited that African American men have a higher incidence of advanced disease. However, multiple large series have shown that rates of upgrading or upstaging among men with low‐risk cancer characteristics are not affected by race . In addition, a recent massive cohort of men from SEER, the Veterans Administration, and Radiation Therapy Oncology Group trials showed that, after adjusting for access to care and standardization of treatment, men of African ancestry did not have an increased risk of cancer‐specific mortality .…”

Race, tumor location, and disease progression among low‐risk prostate cancer patients

“…2 However, short-and long-term outcomes comparing AA race to CA race have been less consistent. At least four studies [3][4][5][6] have explored both short-and long-term outcomes in low-risk CA and AA men who underwent radical prostatectomy (RP). Two studies that examined biochemical recurrence (BCR)-free survival after RP showed no differences for CA vs AA men, 4,5 while two other studies did find a difference between CA and AA men.…”

“…At least four studies [3][4][5][6] have explored both short-and long-term outcomes in low-risk CA and AA men who underwent radical prostatectomy (RP). Two studies that examined biochemical recurrence (BCR)-free survival after RP showed no differences for CA vs AA men, 4,5 while two other studies did find a difference between CA and AA men. 3,6 In general, studies that found no difference in BCR-free survival across race also found few differences in adverse pathology.…”

“…3,6 In general, studies that found no difference in BCR-free survival across race also found few differences in adverse pathology. [3][4][5][6] One anatomical feature of the prostate that has been less explored for short-and long-term CaP outcomes, both independently and jointly with race, is predominant tumor location, specifically, harboring a predominant anterior tumor could lead to poorer oncologic outcomes for CaP patients, if such tumors are more difficult to detect through standard diagnosis procedures. 7 Both Faisal and colleagues 8 and Tiguert and colleagues 9 found that AA men were more likely to harbor anterior tumors than CA men.…”