Active surveillance ‘an appropriate option’ for some African–American prostate cancer patients
medwireNews: A US study has found no significant difference in outcomes between African–American and White men undergoing active surveillance for intermediate-risk prostate cancer.
“These findings are particularly relevant for those with low-intermediate-risk prostate cancer (which in this study was defined with the criteria for NCCN [National Comprehensive Cancer Network] favorable intermediate-risk disease), a group that is currently considered eligible for [active surveillance] per NCCN guidelines,” say the researchers.
They caution, however, that “the overall risks of poor clinical outcomes were considerable, and methods to improve patient selection and surveillance protocols may be needed to reduce these risks.”
The team collated data from the Veterans Health Administration database on 1007 men (32.8% African American) diagnosed with localized, intermediate-risk prostate cancer between 2001 and 2015 and initially managed with active surveillance, defined as no definitive treatment within the first year of diagnosis and at least one additional biopsy after the diagnostic procedure.
As reported in Cancer, the median time to definitive treatment was identical for both African–American and White patients, at 2.6 years.
And there were also no significant differences in any of the outcome measures between African–American and White patients regardless of whether they had low- or high-intermediate-risk disease, where the latter was defined on the basis of the NCCN criteria for unfavorable intermediate-risk prostate cancer.
For instance, in the low-intermediate-risk group (n=773), the 10-year cumulative rates of definitive treatment were a comparable 83.5% and 80.6% among African–American and White men, respectively, with corresponding rates in the high-intermediate-risk group (n=234) of 81.4% and 77.0%.
The 10-year cumulative incidence of disease progression was similarly comparable between African–American and White participants with low-intermediate-risk disease (46.8 vs 46.9%), and this was also the case for the 10-year rates of metastasis (7.1 vs 10.8%), prostate cancer-specific mortality (3.8 vs 3.8%), and all-cause mortality (25.6 vs 26.5%).
“Furthermore, we did not identify substantial differences in follow-up or treatment, including more frequent rebiopsy or earlier definitive treatment, that might mitigate worse outcomes for African American men,” say Brent Rose and colleagues, from the University of California San Diego in La Jolla, USA.
The median numbers of biopsies and prostate-specific antigen tests were identical in the African–American and White participants, at two and 12, respectively, but the median time to biopsy was “slightly but significantly longer” in the former group, at 1.5 versus 1.2 years, they report.
Rose et al therefore write: “Overall, these data suggest that [active surveillance] may be an appropriate option for both African American and White men with low-intermediate-risk prostate cancer after careful selection.”
They believe that “[t]he current study adds to the growing body of literature suggesting that a substantial proportion of race-based health disparities might be directly related to access to care,” and the results “argue against the common belief that prostate cancer is inherently more aggressive than suggested by tumor characteristics in African American men.”
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