Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

Abstract

Radical prostatectomy (RP) outcomes have been studied in White and Black non-Hispanic men qualifying for Epstein active surveillance criteria (EASC). Herein, we first analyzed such outcomes in White Hispanic men. We studied 70 men with nonpalpable Gleason score 3+3 = 6 (Grade Group [GG] 1) prostate cancer (PCa) with ≤2 positive cores on biopsy who underwent RP. In 18 men, prostate-specific antigen (PSA) density (PSAD) was >0.15 ng/mL/g. Three of these had insignificant and 15 had significant PCa. The remaining 52 men qualified for EASC. One patient had no PCa identified at RP. Nineteen (37%) had significant PCa defined by volume (n = 7), grade (n = 7), and volume and grade (n = 5). Nine cases were 3+4 = 7 (GG 2) (5/9 [56%] with pattern 4 <5%), 2 were 3+5 = 8 (GG 4), and 1 was 4+5 = 9 (GG 5). Patients with significant PCa more commonly had anterior dominant disease (11/19, 58%) versus patients with insignificant cancer (7/33, 21%) (P = 0.01). In 12 cases with higher grade at RP, the dominant tumor nodule was anterior in 6 (50%) and posterior in 6 (median volumes: 1.1 vs. 0.17 cm3, respectively; P = 0.01). PSA correlated poorly with tumor volume (r = 0.28, P = 0.049). Gland weight significantly correlated with PSA (r = 0.54, P < 0.001). While PSAD and PSA mass density correlated with tumor volume, only PSA mass density distinguished cases with significant disease (median, 0.008 vs. 0.012 μg/g; P = 0.03). In summary, a PSAD threshold of 0.15 works well in predicting significant tumor volume in Hispanic men. EASC appear to perform better in White Hispanic men than previously reported outcomes for Black non-Hispanic and worse than in White non-Hispanic men. Significant disease is often Gleason score 3+3 = 6 (GG 1) PCa >0.5 cm3. Significant PCa is either a larger-volume anterior disease that may be detected by multi-parametric magnetic resonance imaging-targeted biopsy or anterior sampling of the prostate or higher-grade smaller-volume posterior disease that in most cases should not pose immediate harm and may be detected by repeat template biopsies.

Cancer health disparities in racial/ethnic minorities in the United States

“…210 The rate of under-diagnosis seems to be the highest for AA/Bs, followed by Hispanics/Latinos and then NHWs. [211][212][213] Individuals from racial/ethnic minority populations and uninsured patients are more likely to experience delays in treatment than insured, NHW individuals, 48,53 and the treatment for AA/B men with high-risk/aggressive prostate cancer is less likely to be definitive (involving surgery or radiation); these disparities are the greatest in low-income communities. 214 Furthermore, men from racial/ethnic minority populations and those on a lower income reported worse bowel and urinary function and more sexual dysfunction than NHW men after radical prostatectomy or radiation, which might reflect poorer-quality treatment and follow-up care, as well as the disadvantages prior to treatment.…”

Understanding PSA and its derivatives in prediction of tumor volume: addressing health disparities in prostate cancer risk stratification

“…Studies describing biological differences in tumor volume, location [ 5 ], PSA production [ 20 ], and performance of AS criteria [ 4 ] in NHB men provide useful information to enact meaningful changes in clinical screening and management of PCa. Despite recently reported inconsistencies in AS performance across NHW, NHB, and Hispanic/Latino men who underwent RP [ 4 , 5 , 10 ], AS criteria do not yet include race or ethnicity as variables.…”

“…To verify the accuracy of documented ethnicity in the medical record, this variable was confirmed through a standardized algorithm established by the North American Association of Central Cancer Registries, the National Hispanic Identification Algorithm (NHIA) [ 10 , 32 ]. NHIA systematically classifies surnames as heavily, generally, moderately, occasionally, or rarely Hispanic based on the 1990 U.S. Census Spanish Surname List.…”

“…Many screening tools used for determining recommendations for prostate biopsy and appropriateness of AS have yet to be adequately explored in Hispanic/Latino men, the largest minority population in the United States [ 8 ]. Despite having a greater relative risk of PCa-specific mortality [ 9 ] and recently demonstrating worse radical prostatectomy (RP) outcomes compared to NHW men [ 10 ], relatively little is known about the clinicopathologic profile of Hispanic/Latino men in the setting of risk stratification for prostate biopsy and AS.…”

“…PSAD is one of the five factors within the original and modified Epstein AS criteria [ 4 , 19 ]. With evidence suggesting racial differences in PSA production [ 6 , 20 ] and in the predictability of AS criteria [ 4 , 5 , 10 ], investigating the use of PSA-based tests in risk stratification of racially and ethnically diverse patient populations becomes increasingly important. To our knowledge, only one study has attempted to explore PSAD in Hispanic/Latino men; that study showed similar PSA with higher PSAD levels amongst Hispanic/Latino compared to NHW men, but did not account for disease severity or BMI [ 21 ].…”