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?

Debasish Sundi, Ashley E. Ross, Elizabeth B. Humphreys, Misop Han, Alan W. Partin, H. Ballentine Carter, Edward M. Schaeffer

Research output: Contribution to journalArticle

Abstract

Purpose Active 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. Results AA men with very low-risk PCa had more adverse pathologic features at RP and poorer oncologicoutcomes. 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). Conclusion AA 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.

Original languageEnglish (US)
Pages (from-to)2991-2997
Number of pages7
JournalJournal of Clinical Oncology
Volume31
Issue number24
DOIs
StatePublished - Aug 20 2013

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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