Article

African American Men With Very Low-Risk Prostate Cancer Exhibit Adverse Oncologic Outcomes After Radical Prostatectomy: Should Active Surveillance Still Be an Option for Them?

All authors: Johns Hopkins University, Baltimore, MD.
Journal of Clinical Oncology (Impact Factor: 18.43). 06/2013; 31(24). DOI: 10.1200/JCO.2012.47.0302
Source: PubMed

ABSTRACT PURPOSEActive surveillance (AS) is a treatment option for men with very low-risk prostate cancer (PCa); however, favorable outcomes achieved for men in AS are based on cohorts that under-represent African American (AA) men. To explore whether race-based health disparities exist among men with very low-risk PCa, we evaluated oncologic outcomes of AA men with very low-risk PCa who were candidates for AS but elected to undergo radical prostatectomy (RP). PATIENTS AND METHODS
We studied 1,801 men (256 AA, 1,473 white men, and 72 others) who met National Comprehensive Cancer Network criteria for very low-risk PCa and underwent RP. Presenting characteristics, pathologic data, and cancer recurrence were compared among the groups. Multivariable modeling was performed to assess the association of race with upgrading and adverse pathologic features.ResultsAA men with very low-risk PCa had more adverse pathologic features at RP and poorer oncologic outcomes. AA men were more likely to experience disease upgrading at prostatectomy (27.3% v 14.4%; P < .001), positive surgical margins (9.8% v 5.9%; P = .02), and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system (CAPRA-S) scores. On multivariable analysis, AA race was an independent predictor of adverse pathologic features (odds ratio, [OR], 3.23; P = .03) and pathologic upgrading (OR, 2.26; P = .03). CONCLUSIONAA men with very low-risk PCa who meet criteria for AS but undergo immediate surgery experience significantly higher rates of upgrading and adverse pathology than do white men and men of other races. AA men with very low-risk PCa should be counseled about increased oncologic risk when deciding among their disease management options.

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Available from: Debasish Sundi, Apr 11, 2014
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    • "The degree to which biologic/genetic differences, socioeconomic determinants, delayed diagnosis, access to care, and patterns of care contribute to poorer CaP outcomes for AA men is largely unknown [12]. Although efforts have been made to elucidate the effect of these factors on racial disparities in CaP outcomes [13] [14] [15] [16], there is a paucity of literature examining the relationship between insurance status and racial disparities and its association with cancer care patterns in the context of aggressive cancers. With the implementation of the Affordable Care Act (ACA) and ongoing expansion of health insurance coverage, it is critically important to understand the influence health insurance may have on racial treatment patterns in cancer care [17]. "
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