Reclassification Rates Are Higher Among African American Men Than Caucasians on Active Surveillance

Sundi, Debasish; Faisal, Farzana A.; Trock, Bruce J.; Landis, Patricia; Feng, Zhaoyong; Ross, Ashley E.; Carter, H. Ballentine; Schaeffer, Edward M.

doi:10.1016/j.urology.2014.08.014

Cited by 66 publications

(48 citation statements)

References 20 publications

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“…Also focusing on very low- or low-risk patients, Iremashvili et al 15 (Miami), Abern et al 16 (Duke), and our group 17 have shown that among men on active surveillance in 3 separate cohorts, AA men are at higher risk of disease progression. Taken together with our present findings, these studies question the accuracy of current active surveillance entry criteria for AA men and underscore the need to develop race-specific risk stratifications.…”

Section: Commentmentioning

confidence: 73%

Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

Faisal

Sundi

Cooper

et al. 2014

Urology

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OBJECTIVE To report race-based outcomes after radical prostatectomy (RP) in a cohort stratified by National Comprehensive Cancer Network (NCCN) risk category with updated follow-up. MATERIALS AND METHODS Studies describing racial disparities in outcomes after RP are conflicting. We studied 15,993 white and 1634 African American (AA) pretreatment-naïve men who underwent RP at our institution (1992–2013) with complete preoperative and pathologic data. Pathologic outcomes were compared between races using appropriate statistical tests; biochemical recurrence (BCR) for men with complete follow-up was compared using multivariate models that controlled separately for preoperative and postoperative covariates. RESULTS Very low- and low-risk AA men were more likely to have positive surgical margins (P <.01), adverse pathologic features (P <.01), and be upgraded at RP (P <.01). With a median follow-up of 4.0 years after RP, AA race was an independent predictor of BCR among NCCN low-risk (HR, 2.16; P <.001) and intermediate-risk (hazard ratio [HR], 1.34; P = .024) classes and pathologic Gleason score ≤6 (HR, 2.42; P <.001) and Gleason score 7 (HR, 1.71; P <.001). BCR-free survival for very low-risk AA men was similar to low-risk white men (P = .890); BCR-free survival for low-risk AA men was similar to intermediate-risk white men (P = .060). CONCLUSION When stratified by NCCN risk, AA men with very low-, low-, or intermediate-risk prostate cancer who undergo RP are more likely to have adverse pathologic findings and BCR compared with white men. AA men with “low risk” prostate cancer, especially those considering active surveillance, should be counseled that their recurrence risks can resemble those of whites in higher risk categories.

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Section: Commentmentioning

confidence: 73%

Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

Faisal

Sundi

Cooper

et al. 2014

Urology

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“…However, data from Johns Hopkins show that AA men with very low risk disease are at significant risk of disease reclassification (upgrading) when on AS, and are more likely to demonstrate adverse pathologic features after prostatectomy. 22, 23 Therefore, a significant percentage of AA men classified as low risk disease may in fact harbor high risk disease and are being undertreated. To add to this, it has been previously reported that compared to White men, AA are monitored less frequently when receiving WW/AS.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?

Moses

Orom

Brasel

et al. 2017

Urology

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Objectives To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer among the various racial groups in the US exist, which may be a source of potential disparity in outcome. Methods Utilizing Surveillance, Epidemiology and End Results (SEER) -17, we identified 327,636 men diagnosed with prostate cancer from 2004–2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity. Results African-American and Hispanic men were less likely to receive treatment compared to White men (OR 0.73, 95% CI 0.71,0.75; and OR 0.95, 95% CI 0.92,0.98; respectively). African-American men had significantly lower odds ratio of receiving definitive treatment within each D’Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (Low risk OR 0.81, 95% CI 0.78,0.85; Intermediate risk OR 0.74, 95% CI 0.71,0.77; and High risk OR 0.62, 95% CI 0.58,0.66). Hispanic men with intermediate risk (OR 0.89, 95% CI 0.84,0.94) or high risk (OR 0.79, 95% CI 0.72,0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D’Amico classification. Conclusions There is a significant disparity in the receipt of treatment for prostate cancer among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer prostate cancer-related outcomes in these populations.

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“…Their study included 139 men (67 of whom were African-Americans) with Gleason score ≤6, <33% positive cores, <50% core involvement, and PSA level ≤10 ng/ml evaluated on AS from July 2005 to October 2012. In the Johns Hopkins experience of 654 men (including 39 African-Americans) on AS with clinical stage ≤T1, Gleason score ≤6, PSA level <10 ng/ml, PSA density <0.15 ng/ml/cm 3 , <3 positive cores, and ≤50% cancer per core, African-American men were more than twice as likely to experience upgrading on serial biopsy than white men (36% versus 16%) and African-American race was an independent predictor of biopsy reclassification (HR 1.8, 95% CI 1.23-2.65, P = 0.003) 94 . The findings from each of these studies are limited by the sample size, but the consistency of African-American race as a predictor of disease progression is concerning.…”

Section: Treatment Outcome Differences For Localized Cancermentioning

confidence: 96%

Prostate cancer in men of African origin

2015

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Men of African origin are disproportionately affected by prostate cancer: prostate cancer incidence is highest among men of African origin in the USA, prostate cancer mortality is highest among men of African origin in the Caribbean, and tumour stage and grade at diagnosis are highest among men in sub-Saharan Africa. Socioeconomic, educational, cultural, and genetic factors, as well as variations in care delivery and treatment selection, contribute to this cancer disparity. Emerging data on single-nucleotide-polymorphism patterns, epigenetic changes, and variations in fusion-gene products among men of African origin add to the understanding of genetic differences underlying this disease. On the diagnosis of prostate cancer, when all treatment options are available, men of African origin are more likely to choose radiation therapy or to receive no definitive treatment than white men. Among men of African origin undergoing surgery, increased rates of biochemical recurrence have been identified. Understanding differences in the cancer-survivorship experience and quality-of-life outcomes among men of African origin are critical to appropriately counsel patients and improve cultural sensitivity. Efforts to curtail prostate cancer screening will likely affect men of African origin disproportionately and widen the racial disparity of disease.

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Reclassification Rates Are Higher Among African American Men Than Caucasians on Active Surveillance

Cited by 66 publications

References 20 publications

Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

Racial Disparities in Oncologic Outcomes After Radical Prostatectomy: Long-term Follow-up

Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?

Prostate cancer in men of African origin

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