Active surveillance and African-American ethnicity

There have been reports in the recent past that active surveillance may be less appropriate for African-American men than it is for others; and then there have been reports that did not show such an effect.

In a new study presented at the annual meeting of the American Urological Association in San Diego earlier this week, Leapman et al. (abstract no. PD42-03) presented new data suggesting that appropriately selected African-American men did just as well on active surveillance as Caucasians, based on a retrospective analysis of patients enrolled into the Shared Equal Access Regional Cancer Hospital (SEARCH) database. A report on this study is also available on the UroToday web site.

The research team from the University of California, San Francisco looked at data from 895 men with clinically low-risk prostate cancer (Gleason 3 + 3 = 6, clinical stage ≤ T2a, and PSA ≤ 10 ng/ml), placing a special emphasis on men of African-American and and Caucasian ethnicity.  Here is what they found:

  • 355 African Americans and 540 Caucasian men met the study’s inclusion criteria.
  • Compared to the Caucasian men, at the time of diagnosis, the African-American men
    • Were significantly younger (59.5 years vs. 62.0 years)
    • Had a higher median PSA level (5.5 vs. 5.1 ng/ml)
  • However, compared to the Caucasian men, the African-American men showed no difference between the odds ratios for
    • Gleason score upgrade (from 3 + 3 = 6 to ≥ 3 + 4 =7)
    • Major Gleason score upgrade (from 3 + 3 = 6 to ≥ 4 + 3 = 7)
    • Upstaging (from clinical stage cT2a to pT3a or higher)
    • The presence of positive surgical margins
  • There were also no differences, after radical prostatectomy, in the 5-year recurrence-free survival rates between the races.

While the authors note the importance of considering risk for upgrading and upstaging in all patients being considered as candidates for management on active surveillance, they also conclude that active surveillance appears to be a management option that is just as reliable for African Americans as it appears to be for Caucasians (assuming that all such patients have been appropriately selected).

One Response

  1. Dr. Cooperberg, a well-known urologist from UCSF, is the senior author for this abstract. He is playing a prominent role in the active surveillance (AS) program at UCSF, one of the major AS programs in the world, and had addressed the question of suitability of active surveillance for African nen in a previous paper. That paper was based on data from UCSF and another center, as compared to the SEARCH database that included a number of other centers for the abstract above. The abstract covered 82 more African American participants than the earlier paper. Dr. Cooperberg had also included a couple of minutes on this question at minute 20’06’, available on DVD, in his talk on active surveillance at the 2015 Prostate Cancer Conference (September)

    In that talk he provided a slide on the Johns Hopkins study (available in full on line at no cost) that found “much higher rates of under-sampled disease among African Americans (more anterior tumors)”. Dr. Cooperberg stated that the Johns Hopkins findings had not been replicated in some other studies, including research involving his institution, UCSF, but implied that some other papers were in line with the Johns Hopkins work. At the time of his talk in September 2015, he felt that African-American men should not be excluded from active surveillance but might be good candidates for MRI and closer monitoring. At that time his latest relevant, published research, noted above, indicated no significant differences between African-American men and others for upgrading and upstaging but a significantly higher proportion of positive surgical margins. The authors noted a relatively low proportion of African-American men in the group.

    The current abstract, with a somewhat larger number of African American men, suggests a more favorable picture. However, the relatively weak statistical confidence levels, likely due in large part to the limited number of African Americans in the study, indicate that accidental grouping of men for this study (“random chance”) may be giving us a misleading result. Hopefully that is not the case and will become clear in the near future.

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