226 Increased Incidence of Pathologically Non-Organ Confined Prostate Cancer in African-American Men Eligible for Active Surveillance

Abstract

OBJECTIVE-To compare the clinicopathologic findings of African-American (AA) and WhiteAmerican (WA) men with prostate cancer (PCa) who were candidates for active surveillance (AS) and underwent radical prostatectomy (RP).METHODS-Prospectively maintained database of men who underwent RP from 2 academic centers were analyzed retrospectively. Postoperative pathologic characteristics of patients who met the AS inclusion criteria of the University of California, San Francisco (UCSF) and National Comprehensive Cancer Network (NCCN) were evaluated. After RP, the rate of pathological upstaging and Gleason upgrading were compared between AA and WA men.RESULTS-In the AA cohort, 196 and 124 men met the UCSF and NCCN criteria for AS, respectively. With respect to WA patients, 191 and 148 fulfilled the AS criteria for UCSF and NCCN, respectively. AA men had a higher percentage of maximum biopsy core than WA men (15.3%-20.4% vs 11.5%-15.0%, P <.05, respectively) in both cohorts. In addition, a greater proportion of AA men had multiple positive biopsy cores compared to WA men (45.2% vs 33.1%, P = .046) under the NCCN criteria. A higher proportion of AA men were upstaged (≥pT3) compared to WA men (19.4% vs 10.1%, P = .037). A multivariate regression test revealed that age, preoperative PSA, and number of positive cores were independent predictors of more advanced disease (upstaging and/or upgrading) in AA men.CONCLUSION-AA men who were candidates for AS criteria had worse clinicopathological features on final surgical pathology thanWA men. These results suggest that a more stringent AS criteria should be considered in AA men with prostate cancer.African-American (AA) men have a relatively higher risk of developing prostate cancer (PCa) and dying of PCa compared to White-American (WA) men. 1-4 Between 2004 and2008, in the United States, the annual PCa incidence and mortality rates for AA men were 230.8 and 54.9 (per 100,000), respectively; whereas the respective rates for WA men were 142.8 and 22.4 (per 100, 000), respectively. 5 Although the precise reason for this racial disparity is uncertain, higher tumor grade at initial diagnosis, more aggressive tumor behavior, and poorer access to care in AA men have been suggested to contribute to these differences. 1,3,6,7 Active surveillance (AS) is an acceptable treatment option for men with low risk PCa. However, there is reluctance among health care providers and patients in accepting AS as a viable treatment option for PCa because of the inaccuracy of clinical staging. 8 In this regard, it has been reported that in men who are eligible for AS, the risk of nonorgan-confined disease (pathological upstaging) at radical prostatectomy (RP) ranges from 5%-13.7%. [9][10][11][12] Because AA men tend to have a more aggressive disease at diagnosis compared to WA men, 13,14 it is unclear whether the same AS criteria should be applied to AA men. For example, Iremashvili et al 15 recently reported that AA patients on AS have a significantly higher risk of progression than their WA coun...

Expectant management for men with early stage prostate cancer

“…Results from recent studies have caused some concern over the appropriateness of active surveillance for black men. At Johns Hopkins, black men who met clinical criteria for very‐low‐risk prostate cancer had a significantly higher risk of pathologic upgrading, upstaging, and positive surgical margins at the time of radical prostatectomy . However, this may be related to differences in the distribution of tumors among black men.…”