Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance.
Findings In this retrospective cohort study that included 8726 men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression (59.9% vs 48.3%) and definitive treatment (54.8% vs 41.4%), but not metastasis (1.5% vs 1.4%) or prostate cancer–specific mortality (1.1% vs 1.0%).
Meaning Among African American men with low-risk prostate cancer, active surveillance was associated with increased risk of disease progression and definitive treatment compared with non-Hispanic White men, but not increased mortality; however, longer-term follow-up is needed to better understand mortality risk.
There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men.
To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance.
Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020.
Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy.
Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer-specific mortality, and all-cause mortality.
The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .49); of prostate cancer-specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, -0.9% to 3.1%]; P = 0.09).
In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer-specific mortality. Longer-term follow-up is needed to better assess the mortality risk.
JAMA. 2020 Nov 03 [Epub]
Rishi Deka, P Travis Courtney, J Kellogg Parsons, Tyler J Nelson, Vinit Nalawade, Elaine Luterstein, Daniel R Cherry, Daniel R Simpson, Arno J Mundt, James D Murphy, Anthony V D'Amico, Christopher J Kane, Maria Elena Martinez, Brent S Rose
VHA San Diego Health Care System, La Jolla, California., Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla., Department of Radiation Oncology, Harvard Medical School, Cambridge, Massachusetts., Department of Urology, University of California San Diego School of Medicine, La Jolla., Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33141207
Related Content:
Active Surveillance Safe for African Americans with Low-Risk Prostate Cancer