Prostate Cancer Pathologic Features Worse in Blacks
Black men undergoing radical prostatectomy for prostate cancer are more likely to have indications for adjuvant radiotherapy compared with white men.
|The following article is part of conference coverage from the 2018 Genitourinary Cancers Symposium in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from GU 2018.|
Black men are more likely to have adverse pathologic features found at the time of radical prostatectomy (RP) for prostate cancer (PCa), independent of socioeconomic and clinical factors, investigators concluded in a study presented at the 2018 Genitourinary Cancers Symposium.
These adverse pathologic features increase their risk of biochemical recurrence and more frequently lead to an indication for adjuvant radiation therapy, according to Gregory Arthur Jordan, a third-year medical student at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and colleagues.
Using the National Cancer Database, the investigators identified 313,013 men diagnosed with PCa from 2004 to 2014 and who underwent RP. The group included 256,315 whites (85%), 33,725 blacks (11%), and 12,973 patients of other races.
Significantly higher proportions of blacks than whites had Gleason grade group 2 cancer (46% vs 37.7%), PSA levels of 10 ng/mL or higher (18.5% vs 15.9%), and clinical stage T2b disease (17.8% vs 13.8%).
On multivariable analysis, the odds of having indications for adjuvant radiotherapy (pT3 disease or higher or positive surgical margins) were 21% greater among blacks than whites. Blacks had 26% greater odds of having positive surgical margins, but 23% lower odds of having pT3 or higher disease.
As for what might explain the findings, Jordan noted that black men may be more likely to harbor certain genetic polymorphorisms that give rise to more aggressive PCa. He pointed out that an autopsy study revealed that black men are more likely to have cancer in the anterior of their prostate, which could be a cause of pathologic upstaging. Another possibility is the low vitamin D, which has been linked to an increased risk of aggressive cancer. Jordan explained that black people in general have low vitamin D levels, possibly as a result of their darker skin. He cited a study published in the Journal of Clinical Oncology (2016;34:1345-1349) showing that insufficiency or deficiency of serum vitamin D is associated with increased odds of adverse pathologic findings in men with localized PCa undergoing RP.
Jordan GA, Bhasin R, Block A, et al. The impact of race on adverse pathologic features at the time of radical prostatectomy in men with prostate cancer and implications for adjuvant radiotherapy. Data presented at the 2018 Genitourinary Cancers Symposium, held in San Francisco Feb. 8–10. Abstract 75.
Nyame YA, Murphy AB, Bowen DK, et al. Associations between vitamin D and adverse pathology in men undergoing radical prostatectomy. J Clin Oncol. 2016;34:1345-1349)