Race is associated with discontinuation of active surveillance of low-risk prostate cancer: Results from the Duke Prostate Center

Abern, Michael R.; Bassett, Mitchell; Tsivian, Matvey; Bañez, Lionel L.; Polascik, Thomas J.; Ferrandino, Michael N.; Robertson, Cary N.; Freedland, Stephen J.; Moul, Judd W.

doi:10.1038/pcan.2012.38

Cited by 71 publications

(58 citation statements)

References 38 publications

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“…These disparate findings were derived mainly retrospectively from cohorts with varying sociodemographics, clinical risk, treatment regimens, and follow-up. Among men with PCa managed with AS, AA race has been linked to discontinuation of surveillance followed by active treatment [20]. After RP for all-risk localized disease, AA men have been found to have more adverse pathologic features [21].…”

Section: Discussionmentioning

confidence: 99%

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

et al. 2015

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Background: African American (AA) men suffer a higher prostate cancer (PCa) burden than other groups. Objective: We aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance. Design, setting, and participants: We studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site. Results and limitations: Of 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n = 273; 6.5%), Caucasian (n = 3771; 89.1%), or other racial/ethnic group (Other; n = 187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: AE7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups ( p < 0.01). We found an association between race group and PSM rate ( p < 0.03), with higher odds of PSMs in AA men versus Caucasian men (odds ratio [OR]: 1.64; 95% confidence interval [CI], 1.08-2.47). No statistically significant associations between race and rates of upgrading and upstaging were found. This study was limited by the relatively low proportion of AA men in the cohort. Conclusions: Among clinically low-risk men who underwent RP, AA men had a higher likelihood of PSMs compared with Caucasian men. We did not find statistically significantly different rates of upgrading and upstaging between the race groups. Patient summary: We analyzed two large groups of men with what appeared to be lowrisk prostate cancer based on the initial biopsy findings. The likelihood of finding worse disease (higher grade or stage) at the time of surgery was similar across different racial groups.

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Section: Discussionmentioning

confidence: 99%

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

et al. 2015

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“…13,14 Multiple reports have demonstrated that AA men are more likely to progress to higher-risk disease after enrollment in surveillance. [27][28][29] As such, Sundi et al called into question the generalizability of active surveillance (AS) criteria after showing that 27.3% of AA men who met the AS criteria experienced disease upgrading at RP, a rate nearly twice that of Caucasians. 18 Although multiple factors, including patient preference, are considered in electing AS, PHI may provide helpful information for AA men during counseling.…”

Section: Commentmentioning

confidence: 98%

Prostate Health Index (PHI) Predicts High-stage Pathology in African American Men

Schwen

Tosoian

Sokoll

et al. 2016

Urology

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“…One retrospective study evaluated the effect of race on discontinuation of AS for patients with low-risk PCa. Their results showed that AA men had more aggressive disease and were more likely to progress on AS and proceed to treatment faster than CS men were [27]. A large study on pathologic and FFbF outcomes in very low-risk AA men who qualify for AS but underwent immediate RP showed that AA men had significantly higher rates of upgrading, positive surgical margins, and CAPRA-S score than CS men did [28].…”

Section: Discussionmentioning

confidence: 99%

Novel Nomogram That Predicts Aggressive Disease and Treatment Failure Among African-American Men with Prostate Cancer

Yamoah¹

2014

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Race is associated with discontinuation of active surveillance of low-risk prostate cancer: Results from the Duke Prostate Center

Abstract: Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.

Cited by 71 publications

References 38 publications

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

Prostate Health Index (PHI) Predicts High-stage Pathology in African American Men

Novel Nomogram That Predicts Aggressive Disease and Treatment Failure Among African-American Men with Prostate Cancer

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