Racial disparities affect prostate cancer active surveillance outcomes
medwireNews: African–American men with low-risk prostate cancer are more likely to experience disease progression while under active surveillance, and subsequently receive definitive treatment, than their non-Hispanic White counterparts, US study data show.
The retrospective cohort study included 2280 African–American men (median age 63.2 years) and 6446 non-Hispanic White men (median age 65.5 years) from the US Veterans Health Administration (VHA) Health Care System who were diagnosed with low-risk prostate cancer between 2001 and 2015, and managed with active surveillance.
Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least one additional surveillance biopsy. Both groups received a median of 12 prostate-specific antigen (PSA) tests and a median of two biopsies during follow-up.
Brent Rose (University of California San Diego School of Medicine, La Jolla, USA) and colleagues report in JAMA that the 10-year cumulative incidence of disease progression was significantly higher in the African–American men than in the White men, at 59.9% versus 48.3%.
Statistical analyses revealed that the African–American men were a significant 30% more likely to experience disease progression, 30% more likely to experience a PSA level of 10 ng/dL or greater, and 40% more likely to have a Gleason score greater than 6 after diagnosis.
The researchers also found that the African–American men had a significantly higher cumulative incidence of definitive treatment at 10 years than the White men, at 54.8% versus 41.4%.
By contrast, there was no significant difference between the two racial groups in the 10-year cumulative rates of metastasis (1.5 vs 1.4%), prostate cancer–specific mortality (1.1 vs 1.0%), and all-cause mortality (22.4 vs 23.5%) during a median 7.6 years of follow-up.
Rose and team say that that the lack of difference in these longer-term outcomes suggests that “African American men should not be excluded from active surveillance protocols” but suggest that a longer follow-up period “is needed to better assess the mortality risk.”
In an accompanying editorial, Ronald Chen (University of Kansas, Kansas City, USA) and co-authors say that although the findings “suggest that active surveillance can be safe and effective for Black men, a cautionary note must be raised regarding generalizing results from the equal-access VHA medical centers to more common care contexts.”
They continue: “Because Black patients have more biologically aggressive prostate cancer and higher progression rates during active surveillance compared with White men, there is a greater need for Black men in the general population to have access to high-quality and timely care to avoid delays in diagnosing cancer progression and receiving definitive treatment.”
They conclude that until there is evidence from the broader general population to show that Black men and White men with low-risk prostate cancer have similarly good outcomes while receiving active surveillance, “concerns about biologic differences in prostate cancer between Black and White men and potential disparities in receiving timely surveillance monitoring and treatment on cancer progression may continue to drive lower rates of active surveillance use among Black patients.”
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