Risk evaluation among men initially diagnosed with T1cN0M0 disease


A recent paper in Frontiers in Oncology offers us new information about the risk profiles of men initially diagnosed with clinical stage T1c disease in the USA in relatively recent years.

Zhang et al. used data reported to the US Surveillance, Epidemiology, and End Results (SEER) program between 2004 and 2008 to look at factors that might project higher or lower risk as defined by the D’Amico risk criteria.

Their study showed the following:

  • The database included 70,345 men initially diagnosed with T1cN0M0 disease.
  • Of these 70,345 men, at diagnosis
    • 47.6 percent had low-risk disease (PSA < 10 ng/ml and Gleason score ≤ 6)
    • 35.9 percent had intermediate-risk disease (PSA ≥ 10 but < 20 ng/ml and/or Gleason score 7)
    • 16.5 percent had high-risk disease (PSA ≥ 20 ng/ml and/or Gleason score ≥ 8)
  • At a baseline of 50 years,
    • The estimated potential for high-risk disease among all patients evaluated was more than three times higher for black than for white males (odds ratio [OR] = 3.31).
    • Among men diagnosed with a low PSA (< 10 ng/ml) and T1cN0M0 prostate cancer, the estimated potential for high-risk disease was still nearly three times higher for black than for white males (OR = 2.70).
  • As age increased (per year, after age 50), compared to the probability of diagnosis with low-risk disease,
    • The estimated potential for high-risk disease among all white men was an OR = 1.09.
    • The estimated potential for high-risk disease among the subset of white men with a PSA < 10 ng/ml at diagnosis was again an OR = 1.09.
    • The estimated potential for high-risk disease among all black men men was an OR = 1.06.
    • The estimated potential for high-risk disease among the subset of white men with a PSA < 10 ng/ml at diagnosis was again an OR = 1.06.

The study by Zhang et al. appears to confirm for us (again) that African American race is associated with a far higher, early, initial risk for diagnosis of high-risk prostate cancer than white ethnicity, but that risk increases slightly faster after age 50 among whites than among blacks.

The paper also appears to confirm the importance of very careful evaluation of any African American patient who is considering active surveillance as a management strategy, on the grounds that his real risk for clinically significant disease at time of diagnosis is considerably higher than that of an otherwise comparable white patient.

What is not clear from the abstract of this paper (and we have not seen the full text of the paper) is the degree to which these initial diagnostic factors are affected by subsequent up- or downgrading (i.e., later findings that a patient’s Gleason score was really higher or lower than that initially reported).

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