Active Surveillance for Low-Risk Prostate Cancer in Black Patients

Butler, Santino; Muralidhar, Vinayak; Chavez, Janice; Fullerton, Zoe; Mahal, Amandeep R.; Nezolosky, Michelle D.; Vastola, Marie E.; Zhao, Shuang G.; D’Amico, Anthony V.; Dess, Robert T.; Feng, Felix Y.; King, Martin T.; Mouw, Kent W.; Spratt, Daniel E.; Trinh, Quoc‐Dien; Nguyen, Paul L.; Rebbeck, Timothy R.; Mahal, Brandon A.

doi:10.1056/nejmc1900333

Cited by 46 publications

(35 citation statements)

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“…Between 2010 and 2015, the number of black and nonblack patients with AS/WW increased (29). Our findings show that the difference in PCSM between black and white patients was not statistically significant.…”

Section: Discussionmentioning

confidence: 49%

Cause-specific mortality of low and selective intermediate-risk prostate cancer patients with active surveillance or watchful waiting

Wu¹,

Lv²,

Eftekhar³

et al. 2021

Transl Androl Urol

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Background: Active surveillance or watchful waiting (AS/WW) is increasingly being used as an alternative strategy to radical prostatectomy or radiation therapy for appropriately selected patients with prostate cancer (PCa). However, the prognosis of low-risk and selective intermediate-risk PCa patients after AS/WW is poorly defined. In this study we reviewed the patients registered in the Surveillance, Epidemiology, and End Results (SEER) Program to establish a competing risk nomogram for the prediction of prostate cancerspecific mortality (PCSM). Methods: The information of patients undergoing AS/WW in the SEER program from 2004 to 2015 was obtained. All patients were ISUP (International Society of Urological Pathology) grade 1 or 2 PCa and also fulfilled the National Comprehensive Cancer Network's definition of low-risk PCa [prostate specific antigen (PSA) <10 ng/mL and cT2aN0M0 or less)]. A competing risk nomogram was used to analyze the association of tumor characteristics with PCSM and non-PCSM among the PCa patients with AS/WW. All cases were randomly divided into a training cohort and a validation cohort (1:1). A competing risk nomogram was constructed to predict PCSM in PCa patients with AS/WW. The performance of the PCSM nomogram was evaluated using the concordance index (C-index) and calibration curve. Results: A total of 30,538 PCa patients were identified as low risk or selective intermediate risk with AS/ WW. The 10-year cumulative incidence of death from prostate cancer and death from other cause were 2.8% (95% CI: 2.4-3.1%) and 19.3% (95% CI: 17.8-20.5%), respectively. Variables associated with PCSM included age, marital status, PSA, and ISUP grade. The PCSM nomogram had a good performance in both the training and validation cohorts, with a C-index of 0.744 (95% CI: 0.700-0.781, P<0.001) and 0.738 (95% CI: 0.700-0.777, P<0.001), respectively. Conclusions: Overall, the prognosis was favorable for the low-and selective intermediate-risk PCa patients with AS/WW. The competing risk nomogram yielded a good performance in identifying subgroups of patients with a higher risk of PCSM and potential candidates for AS/WW.

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Section: Discussionmentioning

confidence: 49%

Cause-specific mortality of low and selective intermediate-risk prostate cancer patients with active surveillance or watchful waiting

Wu¹,

Lv²,

Eftekhar³

et al. 2021

Transl Androl Urol

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show abstract

“… 35 Our findings are consistent with prior research in Medicare populations, which also found lower uptake of active surveillance among African American patients, even when controlling for socioeconomic status. 36 Lower rates of conservative management among African American men may be because of patient and/or clinician preference and should be explored through further qualitative work.…”

Section: Discussionmentioning

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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“…The use of nondefinitive local therapy represents an appropriate option for older men with low‐risk disease. This finding is noteworthy in light of recent articles demonstrating decreased utilization of nondefinitive therapy among African American men …”

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confidence: 54%

Reply to Multidisciplinary clinics: A possible means to help to eliminate racial disparities in prostate cancer

Tang

Hoffman

Kuban

2020

Cancer

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Active Surveillance for Low-Risk Prostate Cancer in Black Patients

Cited by 46 publications

References 5 publications

Cause-specific mortality of low and selective intermediate-risk prostate cancer patients with active surveillance or watchful waiting

Cause-specific mortality of low and selective intermediate-risk prostate cancer patients with active surveillance or watchful waiting

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

Reply to Multidisciplinary clinics: A possible means to help to eliminate racial disparities in prostate cancer

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