Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy

Abstract

Purpose Racial disparities in the incidence and risk profile of prostate cancer at diagnosis among African-American men are well reported. However, it remains unclear whether African-American race is independently associated with adverse outcomes in men with clinical low risk disease. Materials and Methods We retrospectively analyzed the records of 895 men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database in whom clinical low risk prostate cancer was treated with radical prostatectomy. Associations of African-American and Caucasian race with pathological biochemical recurrence outcomes were examined using chi-square, logistic regression, log rank and Cox proportional hazards analyses. Results We identified 355 African-American and 540 Caucasian men with low risk tumors in the SEARCH cohort who were followed a median of 6.3 years. Following adjustment for relevant covariates African-American race was not significantly associated with pathological upgrading (OR 1.33, p = 0.12), major upgrading (OR 0.58, p = 0.10), up-staging (OR 1.09, p = 0.73) or positive surgical margins (OR 1.04, p = 0.81). Five-year recurrence-free survival rates were 73.4% in African-American men and 78.4% in Caucasian men (log rank p = 0.18). In a Cox proportional hazards analysis model African-American race was not significantly associated with biochemical recurrence (HR 1.11, p = 0.52). Conclusions In a cohort of patients at clinical low risk who were treated with prostatectomy in an equal access health system with a high representation of African-American men we observed no significant differences in the rates of pathological upgrading, up-staging or biochemical recurrence. These data support continued use of active surveillance in African-American men. Upgrading and up-staging remain concerning possibilities for all men regardless of race.

Disparities in prostate cancer incidence and mortality rates: Solvable or not?

“…In addition, MAA with low‐risk PCa have higher PCa‐specific mortality when treated compared to MEA . However, MAA continues to be enrolled in active surveillance protocols because there are other studies showing no significant upgrading or upstaging after RP . Nonetheless, analysis of active surveillance cohorts report that MAA is more likely to have progression and require active treatment .…”

Race, tumor location, and disease progression among low‐risk prostate cancer patients

“…Margin positivity and pathology Gleason stage were the major predictors of BCR‐free survival in our study, which only slightly differed by race likely due to smaller numbers of AA men (Table ), while race and predominant tumor location did not predict BCR‐free survival. The two previous studies that strictly included low‐risk patients with equal access to health care did not present results for margin status or Gleason stage; however, the SEARCH (Shared Equal Access Regional Cancer Hospital) study found no association (HR = 1.11, 95% CI = 0.81‐1.50, P = .52), while a study from New York Harbor VA hospitals found an association at 5 years (98% CA vs 82% AA, P = .006) for BCR‐free survival, but most likely lacked sufficient CA men for this finding to be replicated . Results from the SEARCH study with all‐risk patients also showed no association between CA and AA race and CaP metastasis (HR = 1.21, 95% CI = 0.87‐1.57, P = .26), CaP specific death (HR = 1.00, 95% CI = 0.61‐1.64, P = .99), and overall death (HR = 1.02, 95% CI = 0.90‐1.17, P = .76) .…”

Use of multiparametric magnetic resonance imaging and fusion‐guided biopsies to properly select and follow African‐American men on active surveillance

“…Additionally, Leapman et al. examined 895 men with LR‐prostate cancer and equal access to medical care, of whom 40% were AA, and found no significantly higher risks of pathological or stage upgrading, positive surgical margins, or BCR. Schulman et al.…”