BACKGROUND: Men with low-risk prostate cancer (CaP) are considered unlikely to die of CaP and have the option of active surveillance.
This study evaluated whether African American (AA) men who present with low-risk disease are at higher risk for death from CaP than white men.
PATIENTS AND METHODS: The authors identified 56,045 men with low-risk CaP (T1-T2a, Gleason score ≤ 6, prostate-specific antigen ≤ 10 ng/mL) diagnosed between 2004 and 2009 using the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing-risks regression analyses were used to analyze the effect of race on prostate cancer-specific mortality (PCSM) after adjusting for known prognostic and sociodemographic factors in 51,315 men (43,792 white; 7523 AA) with clinical follow-up information available.
RESULTS: After a median follow-up of 46 months, 258 patients (209 [0.48%] white and 49 [0.65%] AA men) died from CaP. Both AA race (adjusted hazard ratio [AHR], 1.45; 95% CI, 1.03-2.05; P = .032) and noncurative management (AHR, 1.49; 95% CI, 1.15-1.95; P = .003) were significantly associated with an increased risk of PCSM. When analyzing only patients who underwent curative treatment, AA race (AHR, 1.62; 95% CI, 1.04-2.53; P = .034) remained significantly associated with increased PCSM.
CONCLUSION: Among men with low-risk prostate cancer, AA race compared with white race was associated with a higher risk of PCSM, raising the possibility that clinicians may need to exercise caution when recommending active surveillance for AA men with low-risk disease. Further studies are needed to ultimately determine whether guidelines for active surveillance should take race into account.
Written by:
Mahal BA, Aizer AA, Ziehr DR, Hyatt AS, Choueiri TK, Hu JC, Hoffman KE, Sweeney CJ, Beard CJ, D'Amico AV, Martin NE, Kim SP, Trinh QD, Nguyen PL. Are you the author?
Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Boston, MA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University of California Los Angeles Medical Center, Los Angeles, CA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Reference: Clin Genitourin Cancer. 2014 May 9. pii: S1558-7673(14)00081-0.
doi: 10.1016/j.clgc.2014.04.003
PubMed Abstract
PMID: 24861952
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