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African American men with very-low-risk prostate cancer undergoing prostatectomy still have a higher likelihood of poor oncologic outcomes that should be discussed during counseling, according to results from a retrospective cohort study appearing in the Journal of Clinical Oncology.
Investigators at Johns Hopkins University, Baltimore, studied 1,801 men – 14% African American, 82% white, and 4% other races/ethnicities – treated in the prostate-specific antigen era who met criteria for very-low-risk disease but opted for an immediate radical prostatectomy instead.
Study results showed that relative to white peers, African American men were significantly more likely to have tumors with adverse pathologic features, upgrading at prostatectomy, positive surgical margins, and scores predicting a higher risk of recurrence, Dr. Debasish Sundi and his colleagues reported.
In a multivariate analysis restricted to the 359 men treated with modern practices (extended biopsy sampling and contemporary Gleason grading), African American men had a more than tripling of the odds of adverse tumor features and a more than doubling of the odds of pathologic upgrading relative to men of other races/ethnicities.
The investigators wrote that the study "shows a disparity in outcomes for African American men after radical prostatectomy by multiple metrics, even within a highly selected and contemporary cohort of very-low–risk patients. This underscores the need to develop and use race-based risk classifiers when counseling patients about different management strategies."
"African American men with very low risk of prostate cancer should be counseled about increased oncologic risk when deciding among their disease management options," they recommended.
However, "the results of our study do not support the universal rejection of active surveillance in African American men but rather should promote future studies to address whether alternate race-specific surveillance entry criteria should be used for African American men to ensure oncologic parity with their white counterparts."
The investigators retrospectively studied men undergoing radical prostatectomy at Johns Hopkins since 1992, excluding any who received neoadjuvant hormonal therapy and restricting analyses to those who met National Comprehensive Cancer Network criteria for very-low-risk disease.
Relative to their white peers, African American men were more likely to have upgrading at prostatectomy (27.3% vs. 14.4%), positive surgical margins (9.8% vs. 5.9%), adverse pathologic features (14.1% vs. 7.7%), and a CAPRA-S (Cancer of the Prostate Risk Assessment Post-Surgical scoring system) score of 3 or higher, indicating a higher risk of biochemical recurrence (14.8% vs. 6.9%), the investigators reported (J. Clin. Oncol. 2013 June 17 [doi: 10.1200/JCO.2012.47.0302]).
With a median follow-up of 3 years, African Americans also had a higher rate of biochemical recurrence (4% vs. 1.4%), but the two groups were statistically indistinguishable with respect to metastasis-free, cancer-specific, or overall survival.
In the subset of men treated with modern clinical practices, compared with white men, African American men again had higher rates of upgrading (32.7% vs. 12.6%), positive margins (19% vs. 6.3%), adverse pathology (19.8% vs. 7.2%), and higher CAPRA-S scores (21% vs. 5.7%).
A multivariate analysis in this subset showed that compared with white men and other men combined, African American men still had higher odds of upgrading at prostatectomy (odds ratio, 2.26; P = .03), adverse pathology (OR, 3.23; P = .03), and higher CAPRA-S scores (OR, 6.57; P = .001).
The authors disclosed no potential conflicts of interest.
The findings of Sundi et al. raise two key questions, according to Dr. Matthew R. Cooperberg.
"First, should African American men be considered ineligible for active surveillance on the basis of a higher rate of apparent undersampling?" he wrote. "The answer is of course no, but these higher risks should be included in the information presented during decision-making counseling sessions with African American men newly diagnosed with clinically low-risk prostate cancer."
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Additionally, for those men choosing active surveillance, clinicians may wish to consider relatively more intense surveillance and use of a lower threshold for intervention.
"At least as important as determining the extent to which surveillance protocols should be modified, however, is the more fundamental question posed in the paper and elsewhere: Why are rates of undersampling so much higher among African American men? In other words, in what ways, anatomically or functionally, are prostate cancers fundamentally different across different populations?" Dr. Cooperberg noted.
He proposed that racial/ethnic differences may stem from variations in genetics, diet, and lifestyle, as well as environmental exposure, possibly including chronic psychosocial stress. Furthermore, these factors may interact with differential access to and quality of care.
"Ameliorating the disproportionate prostate cancer disease burden borne by African American men will clearly require a concerted, sustained, multidisciplinary effort," including targeted education and screening, and adequate representation of this population in clinical trials, he concluded.
Dr. Cooperberg is an associate professor of urology at the University of California, San Francisco. He reported no potential conflicts of interest. These remarks were selected from his editorial on the research of Dr. Sundi and associates (J. Clin. Oncol. 2013 July 22 [doi: 10.1200/JCO.2013.50.7723]).http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2013.50.7723
The findings of Sundi et al. raise two key questions, according to Dr. Matthew R. Cooperberg.
"First, should African American men be considered ineligible for active surveillance on the basis of a higher rate of apparent undersampling?" he wrote. "The answer is of course no, but these higher risks should be included in the information presented during decision-making counseling sessions with African American men newly diagnosed with clinically low-risk prostate cancer."
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|
Additionally, for those men choosing active surveillance, clinicians may wish to consider relatively more intense surveillance and use of a lower threshold for intervention.
"At least as important as determining the extent to which surveillance protocols should be modified, however, is the more fundamental question posed in the paper and elsewhere: Why are rates of undersampling so much higher among African American men? In other words, in what ways, anatomically or functionally, are prostate cancers fundamentally different across different populations?" Dr. Cooperberg noted.
He proposed that racial/ethnic differences may stem from variations in genetics, diet, and lifestyle, as well as environmental exposure, possibly including chronic psychosocial stress. Furthermore, these factors may interact with differential access to and quality of care.
"Ameliorating the disproportionate prostate cancer disease burden borne by African American men will clearly require a concerted, sustained, multidisciplinary effort," including targeted education and screening, and adequate representation of this population in clinical trials, he concluded.
Dr. Cooperberg is an associate professor of urology at the University of California, San Francisco. He reported no potential conflicts of interest. These remarks were selected from his editorial on the research of Dr. Sundi and associates (J. Clin. Oncol. 2013 July 22 [doi: 10.1200/JCO.2013.50.7723]).http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2013.50.7723
The findings of Sundi et al. raise two key questions, according to Dr. Matthew R. Cooperberg.
"First, should African American men be considered ineligible for active surveillance on the basis of a higher rate of apparent undersampling?" he wrote. "The answer is of course no, but these higher risks should be included in the information presented during decision-making counseling sessions with African American men newly diagnosed with clinically low-risk prostate cancer."
|
|
Additionally, for those men choosing active surveillance, clinicians may wish to consider relatively more intense surveillance and use of a lower threshold for intervention.
"At least as important as determining the extent to which surveillance protocols should be modified, however, is the more fundamental question posed in the paper and elsewhere: Why are rates of undersampling so much higher among African American men? In other words, in what ways, anatomically or functionally, are prostate cancers fundamentally different across different populations?" Dr. Cooperberg noted.
He proposed that racial/ethnic differences may stem from variations in genetics, diet, and lifestyle, as well as environmental exposure, possibly including chronic psychosocial stress. Furthermore, these factors may interact with differential access to and quality of care.
"Ameliorating the disproportionate prostate cancer disease burden borne by African American men will clearly require a concerted, sustained, multidisciplinary effort," including targeted education and screening, and adequate representation of this population in clinical trials, he concluded.
Dr. Cooperberg is an associate professor of urology at the University of California, San Francisco. He reported no potential conflicts of interest. These remarks were selected from his editorial on the research of Dr. Sundi and associates (J. Clin. Oncol. 2013 July 22 [doi: 10.1200/JCO.2013.50.7723]).http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2013.50.7723
African American men with very-low-risk prostate cancer undergoing prostatectomy still have a higher likelihood of poor oncologic outcomes that should be discussed during counseling, according to results from a retrospective cohort study appearing in the Journal of Clinical Oncology.
Investigators at Johns Hopkins University, Baltimore, studied 1,801 men – 14% African American, 82% white, and 4% other races/ethnicities – treated in the prostate-specific antigen era who met criteria for very-low-risk disease but opted for an immediate radical prostatectomy instead.
Study results showed that relative to white peers, African American men were significantly more likely to have tumors with adverse pathologic features, upgrading at prostatectomy, positive surgical margins, and scores predicting a higher risk of recurrence, Dr. Debasish Sundi and his colleagues reported.
In a multivariate analysis restricted to the 359 men treated with modern practices (extended biopsy sampling and contemporary Gleason grading), African American men had a more than tripling of the odds of adverse tumor features and a more than doubling of the odds of pathologic upgrading relative to men of other races/ethnicities.
The investigators wrote that the study "shows a disparity in outcomes for African American men after radical prostatectomy by multiple metrics, even within a highly selected and contemporary cohort of very-low–risk patients. This underscores the need to develop and use race-based risk classifiers when counseling patients about different management strategies."
"African American men with very low risk of prostate cancer should be counseled about increased oncologic risk when deciding among their disease management options," they recommended.
However, "the results of our study do not support the universal rejection of active surveillance in African American men but rather should promote future studies to address whether alternate race-specific surveillance entry criteria should be used for African American men to ensure oncologic parity with their white counterparts."
The investigators retrospectively studied men undergoing radical prostatectomy at Johns Hopkins since 1992, excluding any who received neoadjuvant hormonal therapy and restricting analyses to those who met National Comprehensive Cancer Network criteria for very-low-risk disease.
Relative to their white peers, African American men were more likely to have upgrading at prostatectomy (27.3% vs. 14.4%), positive surgical margins (9.8% vs. 5.9%), adverse pathologic features (14.1% vs. 7.7%), and a CAPRA-S (Cancer of the Prostate Risk Assessment Post-Surgical scoring system) score of 3 or higher, indicating a higher risk of biochemical recurrence (14.8% vs. 6.9%), the investigators reported (J. Clin. Oncol. 2013 June 17 [doi: 10.1200/JCO.2012.47.0302]).
With a median follow-up of 3 years, African Americans also had a higher rate of biochemical recurrence (4% vs. 1.4%), but the two groups were statistically indistinguishable with respect to metastasis-free, cancer-specific, or overall survival.
In the subset of men treated with modern clinical practices, compared with white men, African American men again had higher rates of upgrading (32.7% vs. 12.6%), positive margins (19% vs. 6.3%), adverse pathology (19.8% vs. 7.2%), and higher CAPRA-S scores (21% vs. 5.7%).
A multivariate analysis in this subset showed that compared with white men and other men combined, African American men still had higher odds of upgrading at prostatectomy (odds ratio, 2.26; P = .03), adverse pathology (OR, 3.23; P = .03), and higher CAPRA-S scores (OR, 6.57; P = .001).
The authors disclosed no potential conflicts of interest.
African American men with very-low-risk prostate cancer undergoing prostatectomy still have a higher likelihood of poor oncologic outcomes that should be discussed during counseling, according to results from a retrospective cohort study appearing in the Journal of Clinical Oncology.
Investigators at Johns Hopkins University, Baltimore, studied 1,801 men – 14% African American, 82% white, and 4% other races/ethnicities – treated in the prostate-specific antigen era who met criteria for very-low-risk disease but opted for an immediate radical prostatectomy instead.
Study results showed that relative to white peers, African American men were significantly more likely to have tumors with adverse pathologic features, upgrading at prostatectomy, positive surgical margins, and scores predicting a higher risk of recurrence, Dr. Debasish Sundi and his colleagues reported.
In a multivariate analysis restricted to the 359 men treated with modern practices (extended biopsy sampling and contemporary Gleason grading), African American men had a more than tripling of the odds of adverse tumor features and a more than doubling of the odds of pathologic upgrading relative to men of other races/ethnicities.
The investigators wrote that the study "shows a disparity in outcomes for African American men after radical prostatectomy by multiple metrics, even within a highly selected and contemporary cohort of very-low–risk patients. This underscores the need to develop and use race-based risk classifiers when counseling patients about different management strategies."
"African American men with very low risk of prostate cancer should be counseled about increased oncologic risk when deciding among their disease management options," they recommended.
However, "the results of our study do not support the universal rejection of active surveillance in African American men but rather should promote future studies to address whether alternate race-specific surveillance entry criteria should be used for African American men to ensure oncologic parity with their white counterparts."
The investigators retrospectively studied men undergoing radical prostatectomy at Johns Hopkins since 1992, excluding any who received neoadjuvant hormonal therapy and restricting analyses to those who met National Comprehensive Cancer Network criteria for very-low-risk disease.
Relative to their white peers, African American men were more likely to have upgrading at prostatectomy (27.3% vs. 14.4%), positive surgical margins (9.8% vs. 5.9%), adverse pathologic features (14.1% vs. 7.7%), and a CAPRA-S (Cancer of the Prostate Risk Assessment Post-Surgical scoring system) score of 3 or higher, indicating a higher risk of biochemical recurrence (14.8% vs. 6.9%), the investigators reported (J. Clin. Oncol. 2013 June 17 [doi: 10.1200/JCO.2012.47.0302]).
With a median follow-up of 3 years, African Americans also had a higher rate of biochemical recurrence (4% vs. 1.4%), but the two groups were statistically indistinguishable with respect to metastasis-free, cancer-specific, or overall survival.
In the subset of men treated with modern clinical practices, compared with white men, African American men again had higher rates of upgrading (32.7% vs. 12.6%), positive margins (19% vs. 6.3%), adverse pathology (19.8% vs. 7.2%), and higher CAPRA-S scores (21% vs. 5.7%).
A multivariate analysis in this subset showed that compared with white men and other men combined, African American men still had higher odds of upgrading at prostatectomy (odds ratio, 2.26; P = .03), adverse pathology (OR, 3.23; P = .03), and higher CAPRA-S scores (OR, 6.57; P = .001).
The authors disclosed no potential conflicts of interest.
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Major finding: Among the subset treated with modern clinical practices, African American men were more likely than white men and other men combined to have upgrading at surgery (OR, 2.26), adverse pathology (OR, 3.23), and higher scores for recurrence (OR, 6.57).
Data source: A retrospective cohort study of 1,801 men with very-low-risk prostate cancer who underwent radical prostatectomy
Disclosures: The authors disclosed no potential conflicts of interest.
