Historically, Asia had a lower prostate cancer (PCa) incidence and mortality compared with Western countries, but the gap is narrowing. Paradoxically, Asians have been reported to present with more advanced disease though more favorable outcomes. Despite PCa becoming an emerging health priority in East Asia, our knowledge remains limited. We compared the prevalence of high-grade PCa on biopsy and disease progression after radical prostatectomy (RP) in East Asian men from Asia and non-East Asian men from Western countries.
This retrospective cohort study included men who underwent prostate biopsy and RP at academic centers in Shanghai, China, and Toronto, Canada (2014-2019). The expanded RP cohort included East Asian men from Singapore (n=282) and non-East Asians from Paris (n=192). Primary endpoints included the proportion of men with Gleason score (GS) ≥8 on biopsy and metastasis-free survival (MFS) after RP for GS ≥8. Multivariable logistic regression and Cox proportional hazard models were performed. Propensity score matching was used to reduce imbalances between cohorts.
PCa was found on biopsy in 2,343 of 4,905 (48%) East Asians and 2,317 of 3,482 (67%) non-East Asians (P<.001). Prostate-specific antigen (PSA) levels at presentation and the proportion of men with GS ≥8 were higher in East Asians than non-East Asians (12.4 vs 6.6 ng/mL and 15.0% vs 8.8%, respectively; both P<.001). On multivariable analysis, there was no difference in the proportion of men with GS ≥8 between matched cohorts with PSA <20 ng/mL (n=3,572; odds ratio, 1.05 [95% CI, 0.77-1.43]; P=.76). No difference in MFS was found after RP between matched cohorts (hazard ratio, 0.97 [95% CI, 0.55-1.70]; P=.92).
This contemporary study demonstrates that East Asian men are equally as likely to harbor aggressive PCa on biopsy as non-East Asian men at PSA levels observed in screening programs, with no difference in disease aggressiveness after RP. The assumption that unfavorable PCa at diagnosis is more common but less aggressive in East Asians should be revisited and viewed in the context of the expected increase in the PCa burden worldwide.
Journal of the National Comprehensive Cancer Network : JNCCN. 2024 Nov 15 [Epub ahead of print]
Liang Dong, Katherine Lajkosz, Rafael Sanchez-Salas, Cynthia Kuk, Wei Xu, Raj Vikesh Tiwari, Caio Pasquali Dias Dos Santos, Hongyang Qian, Jiayi Wang, Baijun Dong, Jiahua Pan, Yinjie Zhu, Qiang Liu, Amy Chan, Jethro C C Kwong, Dixon T S Woon, Michael Nesbitt, Annette Erlich, Girish S Kulkarni, Nathan Perlis, Robert J Hamilton, Laurence Klotz, Christopher J D Wallis, David-Dan Nguyen, Petr Macek, Kae Jack Tay, Honghong Huang, Ants Toi, Antonio Finelli, Neil E Fleshner, Christopher W S Cheng, Xavier Cathelineau, Theodorus H van der Kwast, Wei Xue, Alexandre R Zlotta
1Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., 2Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., 3Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada., 4Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada., 6Department of Urology, Singapore General Hospital, Singapore., 8Department of Urology, L'Institut Mutualiste Montsouris, Paris, France., 9Department of Pathology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., 5Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada., 10Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Canada., 12Department of Medical Imaging, University Health Network, Toronto, Canada., 7Department of Urology, Sengkang General Hospital, Singapore., 13Department of Pathology, University Health Network, Toronto, Canada.