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

Abstract

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.

Prostate Health Index (PHI) Predicts High-stage Pathology in African American Men

“…The underrepresentation of AA men in the majority of cohorts reporting on PHI raises concerns about generalizing existing data to this population. As previously reported, AA men tend to have more aggressive PCa, as demonstrated by higher cancer volumes, 16 Gleason scores (GS), 16,17 and rates of non-organ-confined disease, 18,19 as well as higher rates of biochemical recurrence (BCR) after treatment. [16][17][18] Furthermore, increased genetic markers for aggressive cancer in AAs provide plausibility that biologic differences associated with race may confer significant variation in disease aggressiveness.…”

Cancer patterns, trends and projections in Latin America and the Caribbean: a global context

“…For mortality this may be due in part to the elevated breast and prostate cancer rates among black populations in the sub-region, combined with outcome disparities and an increased risk of death for both cancers, as reported in other settings. [14][15][16][17][18][19] Lung cancer was the first cause of death in two of the sub-regions but warrants cautious interpretation on considering the relatively low rates of lung cancer incidence and the fact that mortality should closely follow incidence given the consistently poor prognosis from this cancer. The underlying inferior quality of death certificates cannot be excluded as a possible explanatory artefact.…”

Cancer Incidence in Appalachia, 2004–2011

“…Prostate IRs are known to be higher in the black population than the white population, approximately 64% higher (17,(34)(35)(36). Black males in Southern Appalachia represent approximately 30% of the male population, compared with 13% in US non-Appalachia, and may, in part, contribute to the higher prostate IR (3).…”