Socioeconomic status largely explains the lower adoption of active surveillance or watchful waiting (AS/WW) by black men with low-risk prostate cancer (PCa), but other factors come into play as well.

Of 50,302 patients in the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting Database, 7517 (14.9%) were black and 42,785 (85.1%) were nonblack. From 2010 to 2015, use of radical prostatectomy and definitive radiation therapy significantly declined from 41.4% and 46.0% to 28.8% and 34.8%, respectively, among black men and from 48.5% and 36.7% to 31.8% and 24.9%, respectively, among nonblack men.

Meanwhile, AS/WW rates nearly tripled, but the increase was significantly smaller for black patients, Brandon A. Mahal, MD, of the Harvard Radiation Oncology Program in Boston, and colleagues reported in a letter in the New England Journal of Medicine. Over the 5-year period, receipt of AS/WW significantly increased from 12.6% to 36.4% among black men and from 14.8% to 43.3% among nonblack men.

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In unadjusted analyses, black men were 7% less likely to receive AS/WW. But this disparity diminished and was no longer significant after adjustment for socioeconomic and insurance status. After multivariable adjustment, the odds of AS/WW for black men vs nonblack men for the years 2010 through 2015 were 1.06, 1.24, 0.97, 1.01, 0.92, and 0.84.

“Still, black men were less likely than nonblack men to receive active surveillance or watchful waiting by 2015, even after adjustment for socioeconomic status — a finding that suggests a possible lower relative uptake of active surveillance or watchful waiting over time for black men,” Dr Mahal and colleagues wrote.


Butler S, Muralidhar V, Chavez J, et al. Active surveillance for low-risk prostate cancer in black patients. N Engl J Med 2019;380:2070-2072. Published online May 22, 2019. doi:10.1056/NEJMc1900333

Black men less likely than nonblack patients to adopt active surveillance for low-risk prostate cancer (news release). Dana-Farber Research Institute; May 22, 2019.