Among men with very-low-risk prostate cancer (PCa) who meet criteria for active surveillance but undergo radical prostatectomy, African-American race is associated with poorer outcomes, with higher rates of disease upgrading and adverse pathology, according to a study published online in the Journal of Clinical Oncology.
To examine whether race-based health disparities exist among men with very-low-risk PCa who undergo prostatectomy, Debasish Sundi, M.D., from Johns Hopkins University in Baltimore, and colleagues studied 1,801 men (256 African-American, 1,473 white, and 72 others) who met National Comprehensive Cancer Network criteria for very low-risk PCa. Comparisons were made by racial group with regards to presenting characteristics, pathologic data, and cancer recurrence.
The researchers found that more adverse pathologic features at prostatectomy and poorer oncologic outcomes were seen for African-American men with very-low-risk PCa. For African-American men, there was an increased likelihood of experiencing disease upgrading at prostatectomy (27.3 versus 14.4 percent; P < 0.001); positive surgical margins (9.8 versus 5.9 percent; P = 0.02); and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system scores. African-American race was an independent predictor of adverse pathologic features and pathologic upgrading (odds ratio, 3.23 and 2.26, respectively), on multivariate analysis.
“African-American men with very-low-risk PCa should be counseled about increased oncologic risk when deciding among their disease management options,” the authors write.