Are African American men good candidates for active surveillance?


Data from what appears to be one of the largest registry studies to date suggest that race does not increase risk for upstaging or upgrading in men who are eligible candidates for active surveillance.

There has now been a good deal of analysis of whether African American men who are diagnosed with prostate cancer are appropriate candidates for initial management on active surveillance. Initial studies had suggested that there might be a problem, but more recent studies seem to have refuted those initial suggestions.

A report by Husainat et al. to be presented at the upcoming annual meeting of the American Urological Association (AUA) will address data from > 3,000 men with favorable-risk forms of prostate cancer included in the state-wide Michigan Urological Surgery Improvement Collaborative (MUSIC) registry.

Husainat et al. identified all men with biopsy-based Gleason scores of 3 + 3 and low-volume 3 + 4 prostate cancer who also met other (standard) criteria for active surveillance as an initial management strategy according to the MUSIC active surveillance appropriateness criteria and who went on to have a radical prostatectomy.

The two primary outcomes being measured in this study were:

  • Evidence of upgrading of Gleason scores at post-surgical pathology as compared to the initial pathology at biopsy
  • Evidence of pathological stage T3 or T4 disease at post-surgical pathology compared to initial clinical stage

Here are the basic study findings:

  • The registry included 3,159 men whose data made them eligible for analysis.
  • Upgrading was evident in 40.7 percent of these patients at surgery.
  • Upstaging was evident in 14.3 percent of these patients at surgery.
  • On multivariable analysis,
    • Five factors had a statistically significant impact (p < 0.05) on risk for upgrading at surgery: age, body mass index (BMI), PSA level at diagnosis, greatest percentage of cancer involvement in positive cores, and presence of Gleason pattern 4 disease in the diagnostic biopsy specimen
    • Four factors had a statistically significant impact (p < 0.05) on risk for upgrading at surgery: age, PSA level at diagnosis, greatest percentage of cancer involvement in positive cores, and presence of Gleason pattern 4 disease in the diagnostic biopsy specimen
  • Patients of African American ethnicity were not at higher risk for tumor upgrading (p = 0.24) or tumor upstaging  (p = 0.75) as compared to white patients.

Husainat et al. conclude that, in their study:

baseline tumor characteristics were affecting the final pathologic outcome, while race did not play a role in the final pathologic grade or stage [of prostate cancer]. According to our results we think that [African American patients with favorable risk forms of prostate cancer] are not at higher risk of tumor upgrade or upstage on surgical intervention.

What we do not know from the currently available data is exactly what percentage of the 3,159 eligible men in the MUSIC database were of African American ethnicity. However, it is probably reasonable to assume that it was at least 200 (6.3 percent) and perhaps considerably more.

Data from other studies to be presented at the AUA’s annual meeting this year appear to reach similar conclusions regarding the risk for active surveillance among African American men diagnosed with prostate cancer, although it does appear that African Americans who are appropriate candidates for initial active surveillance tend to be somewhat younger than comparable white patients.

2 Responses

  1. Did I get it right? There is no difference in outcome on active surveillance whether you are black or white. OK. How is that an argument for more active surveillance for one of the groups (black and white)?

    Did I miss something?

  2. Dear Finn:

    Nowhere in the above commentary is there any suggestion of “an argument for more active surveillance for one of the groups (black and white)”. The whole point of the commentary is that there is no such argument based on the study referred to.

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