Rethinking active surveillance for prostate cancer in African American men

Leinwand, Gabriel; Gabrielson, Andrew; Krane, L. Spencer; Silberstein, Jonathan L.

doi:10.21037/tau.2018.06.19

Cited by 10 publications

(7 citation statements)

References 72 publications

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“…The broad implications of these findings support the idea that all men, regardless of race, can be evaluated accurately with MRI fusion biopsy technology. Furthermore, our evidence supports that AS can be safely considered in this population without fear of imperceivable cancer in the anterior of the prostate in AA men, leading to worse oncologic outcomes [ 16 ]. These findings may later be important to the advances in diagnostics in combination with genetic and biomarker technologies, as well as for treatment options such as focal therapies.…”

Section: Discussionsupporting

confidence: 60%

Prostate Cancer Lesions by Zone and Race: Does Multiparametric MRI Demonstrate Racial Difference in Prostate Cancer Lesions for African American Men?

et al. 2021

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African American (AA) men have increased risk of prostate cancer diagnosis and mortality, but the cause remains unknown. MRI fusion improves diagnosis of localized prostate cancer, particularly in anterior lesions; however, cost and access are limited in a community practice setting. By utilizing a diverse cohort of veterans with equal access to care in a single payer system, we describe prostate cancer detection. We queried a prospectively maintained institutional review board-approved database of men undergoing prostate biopsy for untreated prostate cancer. We included all consecutive patients from October 2017 to February 2020. Statistical analysis including Kaplan–Meier Curves, Fisher’s exact test, and Forest plot was performed. From 246 consecutive patients, 166 were AA and 80 were non-AA. There were similar distributions of PSA, PSAD, and number of targetable lesions between the AA and non-AA cohort (p > 0.05 for all). We found no difference in location on MRI between race groups. There was similar cancer detection, focusing on anterior lesions and rate of positive Gleason grade (≥GG1) and clinically significant (≥GG2) cancer between cohorts. In a predominant AA cohort of veterans, we found similar distribution of location for MRI-targeted lesions, along with rates of tumor detection and aggressiveness of disease. In this single payer veteran population, we did not identify specific biologic differences inherent to tumor detection between AA and non-AA patients.

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Section: Discussionsupporting

confidence: 60%

Prostate Cancer Lesions by Zone and Race: Does Multiparametric MRI Demonstrate Racial Difference in Prostate Cancer Lesions for African American Men?

et al. 2021

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“… 7 This raises the possibility of race-based, biological differences in low-risk prostate cancer and has led to a debate regarding whether African American patients should be candidates for conservative management. 8 , 9 , 10 Understanding racial differences in the uptake and duration of conservative management is key to counseling African American men regarding the risks and benefits of conservative management.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, among Medicare beneficiaries with low-risk prostate cancer, African American men may have higher mortality than non-Hispanic White men, even after controlling for socioeconomic status . This raises the possibility of race-based, biological differences in low-risk prostate cancer and has led to a debate regarding whether African American patients should be candidates for conservative management . Understanding racial differences in the uptake and duration of conservative management is key to counseling African American men regarding the risks and benefits of conservative management.…”

Section: Introductionmentioning

confidence: 99%

Comparison by Race of Conservative Management for Low-Risk and Intermediate-Risk Prostate Cancers in Veterans From 2004 to 2018

et al. 2020

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IMPORTANCE Conservative management (ie, active surveillance or watchful waiting) is a guidelinebased strategy for men with low-risk and intermediate-risk prostate cancer. However, use of conservative management is controversial for African American patients, who have worse prostate cancer outcomes compared with White patients. OBJECTIVE To examine the association of African American race with the receipt and duration of conservative management in the Veterans Health Administration (VA), a large equal-access health system. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the VA Corporate Data Warehouse for 51 543 African American and non-Hispanic White veterans diagnosed with low-risk and intermediate-risk localized node-negative prostate cancer between January 1, 2004, and December 31, 2013. Men who did not receive continuous VA care were excluded. Data were analyzed from February 1 to June 30, 2020. EXPOSURES All patients received either definitive therapy (ie, prostatectomy, radiation, androgen deprivation therapy) or conservative management (ie, active surveillance or watchful waiting). MAIN OUTCOMES AND MEASURES Receipt of conservative management and (for patients receiving conservative management) time from diagnosis to definitive therapy. RESULTS The median (interquartile range) age of the 51 543 veterans in our cohort was 65 (61-70) years, and 14 830 veterans (28.8%) were African American individuals. Compared with White veterans, African American veterans were more likely to have intermediate-risk disease (18 988 [51.7%] vs 8526 [57.5%]), 3 or more comorbidities (15 438 [42.1%] vs 7614 [51.3%]), and high disability-related or income-related needs (9078 [24.7%] vs 4614 [31.1%]). Overall, 20 606 veterans (40.0%) received conservative management. African American veterans with low-risk disease (adjusted relative risk, 0.95; 95% CI, 0.92-0.98; P < .001) and intermediate-risk disease (adjusted relative risk, 0.92; 95% CI, 0.87-0.97; P = .002) were less likely to receive conservative management than White veterans. Compared with White veterans, African American veterans with low-risk disease (adjusted hazard ratio, 1.71; 95% CI, 1.50-1.95; P < .001) and intermediate-risk disease (adjusted hazard ratio, 1.46; 95% CI, 1.27-1.69; P < .001) who received conservative management were more likely to receive definitive therapy within 5 years of diagnosis (restricted mean survival time [SE] at 5 years, 1679 [5.3] days vs 1740 [2.4] days; P < .001). CONCLUSIONS AND RELEVANCE In this study, conservative management was less commonly used and less durable for African American veterans than for White veterans. Prospective trials should (continued) Key Points Question Are there racial differences in receipt and duration of conservative management (ie, active surveillance or watchful waiting) among veterans with low-risk and intermediate-risk prostate cancer? Findings In this cohort study of 51 543 veterans with low-risk and intermediaterisk prostate cancer, African American veterans were less likely than Whi...

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“… 8 Providing extended follow up outcomes is vital to encouraging AS for AA men with low risk disease. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Five-Year Prospective Observational Study of African-American Men on Active Surveillance for Prostate Cancer Demonstrates Race Is Not Predictive of Oncologic Outcomes

et al. 2022

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Introduction This study aimed to evaluate if race impacted outcomes or risk of disease progression in men on active surveillance (AS) for prostate cancer. We present the results from our majority African-American cohort of men in an equal access setting over a 5-year follow-up period. Patients and Methods All patients who elected AS for prostate cancer at the Southeast Louisiana Veterans Health Care System are entered into a prospectively managed observational database. Patients were divided into groups based on self-reported race. Grade group progression was defined as pathologic upgrading above International Society of Urological Pathology Grade Group 1 disease on subsequent biopsies following diagnostic biopsy. All tests were 2 sided using a significance of .05. Results A total of 228 men met inclusion criteria in the study, including 154 non-Hispanic African American and 74 non-Hispanic Caucasian American men, with a median follow-up of 5 years from the initiation of AS. Race was not predictive of Gleason grade progression, AS discontinuation, or biochemical recurrence on Cox multivariate analysis (HR = 1.01, 0.94, 0.85, P = .96, .79, .81, respectively). On Kaplan-Meier analysis at 5 years, African-American progression-free, AS discontinuation free, and overall survival probability was comparable to their Caucasian American counterparts (P > .05 for all). Conclusions Active surveillance is a safe treatment option for low and very low risk prostate cancer, regardless of race. African-American and Caucasian-American men did not have any significant difference in Gleason grade group progression in our cohort with 5-year follow-up.

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Rethinking active surveillance for prostate cancer in African American men

Cited by 10 publications

References 72 publications

Prostate Cancer Lesions by Zone and Race: Does Multiparametric MRI Demonstrate Racial Difference in Prostate Cancer Lesions for African American Men?

Prostate Cancer Lesions by Zone and Race: Does Multiparametric MRI Demonstrate Racial Difference in Prostate Cancer Lesions for African American Men?

Comparison by Race of Conservative Management for Low-Risk and Intermediate-Risk Prostate Cancers in Veterans From 2004 to 2018

Five-Year Prospective Observational Study of African-American Men on Active Surveillance for Prostate Cancer Demonstrates Race Is Not Predictive of Oncologic Outcomes

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