INTRODUCTION: Among men with very-low-risk prostate cancer (PCa) at biopsy, recent evidence has shown that African American men (AA) are at greater risk for adverse oncologic outcomes after radical prostatectomy (RP).
We studied RP specimens from very-low-risk AA and Caucasian men to determine if there were systematic pathological differences.
MATERIALS AND METHODS: RP specimens were evaluated for men with National Comprehensive Cancer Network (NCCN) very-low-risk PCa. All men underwent extended biopsy sampling at diagnosis (≥10 cores) and were treated in the modern Gleason grading era. Tumor volumes, grades, and locations in 87 AA and 89 Caucasians were analyzed. For each specimen, the dominant nodule was defined as the largest tumor with highest grade.
RESULTS: Compared to Caucasians, AA men were more likely to have significant PCa (61% vs 29%, p< 0.001); Gleason ≥7 (37% vs 11%, p< 0.001) and volume >0.5cm3 (45% vs 21%, p=0.001). Dominant nodules in AA men were larger (median 0.28 cm3 vs 0.13 cm3, p=0.002) and more often anterior (51% vs 29%, p=0.003). Among men who underwent pathologic upgrading, the dominant nodule was also anterior more frequently in AA than in Caucasians (59% vs 0%, p=0.001).
CONCLUSIONS: AA men with very-low-risk PCa at diagnosis have a significantly higher prevalence of anteriorly-located cancer foci that are of higher grade and larger volume. Enhanced imaging or anterior zone sampling may detect these significant, anterior tumors, thereby improving outcomes of AA men considering active surveillance.
Written by:
Sundi D, Kryvenko ON, Carter HB, Ross AE, Epstein JI, Schaeffer EM. Are you the author?
Brady Institute of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Reference: J Urol. 2013 Jun 13. pii: S0022-5347(13)04609-0.
doi: 10.1016/j.juro.2013.06.021
PubMed Abstract
PMID: 23770146
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