Racial differences in serum prostate‐specific antigen (PSA) doubling time, histopathological variables and long‐term PSA recurrence between African‐American and white American men undergoing radical prostatectomy for clinically localized prostate cancer

Tewari, Ashutosh; Horninger, Wolfgang; Badani, Ketan K.; Hasan, Mahmudul; Coon, Steven; Crawford, E. David; Gamito, Eduard J.; Wei, John T.; Taub, David A.; Montie, James E.; Porter, Chris; Divine, George; Bartsch, Georg; Menon, Mani

doi:10.1111/j.1464-410x.2005.05561.x

Cited by 32 publications

(22 citation statements)

References 19 publications

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“…After correcting for stage, grade, and other known prognostic factors, race generally is not predictive of worse outcomes in men with prostate cancer. This has been demonstrated in studies of clinically localized prostate cancer [23][24][25] and metastatic disease. Analyses of 5284 men with newly diagnosed, primarily distant-stage disease 26 and of 1183 patients with metastatic, hormone-refractory disease 27 showed no independent effect of race on survival.…”

Section: Discussionmentioning

confidence: 80%

The prognostic value of hemoglobin change after initiating androgen‐deprivation therapy for newly diagnosed metastatic prostate cancer

Beer

Tangen

Bland

et al. 2006

Cancer

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BACKGROUND. The objective of this study was to characterize changes in hemoglobin (HGB) levels after the initiation of androgen‐deprivation therapy (ADT) in patients with previously untreated, metastatic prostate cancer who were enrolled in a large clinical trial. METHODS. The multivariate associations between 3‐month change in HGB and baseline characteristics were evaluated with a linear regression model. The associations between 3‐month change in HGB level and time‐to‐event outcomes, including overall survival and progression‐free survival, were evaluated by using proportional hazards regression models. RESULTS. Quartiles of baseline HGB levels were ≤12.0 g/dL, from 12.1 to 13.7 g/dL, from 13.8 to 14.7 g/dL, and >14.7 g/dL. Overall, 3 months after initiating ADT, the mean HGB level declined 0.54 g/dL (standard deviation [SD], 1.68 g/dL); however, the mean HGB level increased by 0.99 g/dL (SD, 1.83 g/dL) in patients who had baseline HGB levels <12 g/dL and decreased 1.04 g/dL (SD, 1.28 g/dL) in patients who had baseline HGB levels ≥12 g/dL. After adjusting for potential confounders, including baseline HGB level, a decline in HGB after 3 months of ADT was associated independently with shorter survival (hazards ratio [HR], 1.10 per 1 g/dL decline; P = .0035) and shorter progression‐free survival (HR, 1.08 per 1 g/dL decline; P = .013). An unexpected finding was that the effect of baseline HGB on overall and progression‐free survival varied significantly by race. CONCLUSIONS. In a sample of men with newly diagnosed, metastatic prostate cancer, a decline in HGB level after 3 months of ADT was associated with shorter survival and progression‐free survival after adjusting for disease status and other baseline covariates. Although race alone was not a strong predictor of death or disease progression, the effect of the baseline HGB level on overall and progression‐free survival varied significantly by race. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 80%

The prognostic value of hemoglobin change after initiating androgen‐deprivation therapy for newly diagnosed metastatic prostate cancer

Beer

Tangen

Bland

et al. 2006

Cancer

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“…This slightly increased risk was reduced after adjusting for clinical characteristics. Similarly, 2 small studies examining racial differences in disease aggressiveness at the time of disease recurrence, as assessed by PSA doubling time (PSADT), have also found conflicting results 12, 13. Therefore, the association between race and biochemical disease recurrence and disease aggressiveness at the time of recurrence remains unclear.…”

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confidence: 99%

Race, biochemical disease recurrence, and prostate–specific antigen doubling time after radical prostatectomy

Hamilton

Aronson

Presti

et al. 2007

Cancer

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BACKGROUND.Whether black men are at increased risk for biochemical disease recurrence after radical prostatectomy (RP) is debatable. Once black men have developed disease recurrence, it is unknown whether they have more aggressive disease than white men. To address this issue, the authors examined racial differences in pathologic features, time to disease recurrence, and prostate–specific antigen (PSA) doubling time (PSADT) among a cohort of patients treated with RP.METHODS.The authors analyzed 953 white and 659 black men who were treated at 5 medical centers comprising the Shared Equal Access Regional Cancer Hospital (SEARCH) Database between 1988 and 2006. The association between race, adverse pathologic features, and biochemical disease recurrence was examined. Among those patients who developed disease recurrence, time to recurrence and PSADT were compared between the races.RESULTS.Black men were on average 2.1 years younger (P < .001) and had higher median preoperative PSA levels (7.6 ng/mL vs 7.0 ng/mL; P < .001), yet presented with a lower clinical stage of disease (T1: 62% vs 44%; P < .001) and similar biopsy Gleason scores (P = .59). After adjusting for multiple clinical characteristics, black men were found to be as likely as white men to have adverse pathologic features (Gleason score ≥7, positive surgical margins, and seminal vesicle invasion) in the RP specimen and were less likely to have extracapsular extension (P = .03). Black men were more likely to have a biochemical disease recurrence (hazards ratio [HR] of 1.28; 95% confidence interval [95% CI, 1.07–1.54 [P = .006]). This increased risk was reduced slightly after adjustment for multiple clinical and pathologic features, and no longer achieved statistical significance (HR of 1.19; 95% CI, 0.97–1.45 [P = .09]). Among men who developed disease recurrence, the median PSADT was found to be similar among black men (17.0 months) and white men (14.6 months) (P = .26).CONCLUSIONS.Despite presenting with earlier clinical stage and similar pathologic features at RP, black men were found to be at a slightly increased risk for biochemical disease recurrence. However, these recurrences appear to be no more aggressive than those found in white men. Cancer 2007;110:2202–9. © 2007 American Cancer Society.

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“…These studies have consistently shown that with time, differences in outcome by race, have diminished when adjusted for pathologic features [1][2][3][4]. We have recently reported that at our equal-access institution, while disparities in pathologic stage, pretreatment PSA and age at diagnosis between black and white patients have narrowed over time, black patients continue to have significantly worse Gleason scores, suggesting that biological factors might play a role in the poor outcome of PCA in this population5.…”

Section: Introductionmentioning

confidence: 99%

Impact of Socioeconomic Factors on Prostate Cancer Outcomes in Black Patients Treated with Surgery

Dash¹,

Lee²,

Zhou³

et al. 2008

Urology

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Objective-The role of socioeconomic factors in the worse outcome of black men with prostate cancer remains unclear. To determine if socioeconomic factors affect prostate cancer outcomes, we studied a cohort of only black patients to minimize known confounding factors Methods-Black men treated with radical prostatectomy at New York Veterans Administration Medical Center and Memorial Sloan-Kettering Cancer Center between 1990 and 2005 were studied. A centralized pathology review process determined the Gleason score of all cases. PSA recurrence at both sites was defined as PSA ≥ 0.2 with a confirmatory rise. By matching patients' home zip codes to the U.S. Census Bureau database, corresponding socioeconomic data regarding median household income (income) and percentage of population having graduated from high school (education) was obtained. Income, education, clinical and pathological parameters were analyzed for the whole cohort.Results-430 black patients were studied. They resided in neighborhoods where median household income was $41,498.10 and mean percentage of high school graduates was 73.4%. Eighty-eight (20.9%) patients had PSA recurrence. Median follow-up for survivors was 37 months. Neither income nor education evaluated as continuous or categorical variables were predictors of PSA recurrence. When evaluated as composite categorical variable, the combination of greater income and education did not predict disease free survival.Conclusions-Data suggest that socioeconomic factors have limited impact on PSA recurrence in black men treated with radical prostatectomy. Thus, biologic factors might play a role in the poor outcomes in this population.

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Racial differences in serum prostate‐specific antigen (PSA) doubling time, histopathological variables and long‐term PSA recurrence between African‐American and white American men undergoing radical prostatectomy for clinically localized prostate cancer

Cited by 32 publications

References 19 publications

The prognostic value of hemoglobin change after initiating androgen‐deprivation therapy for newly diagnosed metastatic prostate cancer

The prognostic value of hemoglobin change after initiating androgen‐deprivation therapy for newly diagnosed metastatic prostate cancer

Race, biochemical disease recurrence, and prostate–specific antigen doubling time after radical prostatectomy

Impact of Socioeconomic Factors on Prostate Cancer Outcomes in Black Patients Treated with Surgery

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