Black men are more likely than white men to die from Gleason 6 prostate cancer (PCa), according to investigators.

Risk assessment and management of PCa in black men is controversial. To better understand the implications of Gleason score, Brandon A. Mahal, MD, of the Harvard Radiation Oncology Program in Boston, and colleagues compared PCa mortality among 31,841 black and 160,383 nonblack patients diagnosed with localized disease during 2010 to 2015 using the Surveillance, Epidemiology, and End Results Prostate Active Surveillance/Watchful Waiting (SEER AS/WW) database. 

Black men were diagnosed at younger ages (median 62 vs 65 years), and significantly more had cT1 to T2a (81.3% vs 75.3%) and Gleason 7 to 10 disease (60.1% vs 55.8%) than nonblack men. Despite comparable overall PCa death rates (1.44% vs 1.35%), nearly twice as many black men with Gleason 6 died from their cancer (0.40% vs 0.22%) over a median 36 months of follow up, the investigators reported in the Journal of the American Medical Association. Among men with Gleason 6 disease, black men had a 2-fold increased risk of death from PCa compared with nonblack men, after adjusting for potential confounders. 

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The team conducted similar analyses in the general SEER cohort, which included 62,736 black and 340,286 nonblack men over a longer follow-up period. Again, blacks fared significantly worse than nonblacks, especially those with Gleason 6 disease, who were 1.5 times more likely to die from PCa. PCa mortality at 12 years was 2.2% vs 1.4% for Gleason 6 disease and 5.5% vs 5.3% for Gleason 7 to 10 disease. The investigators controlled for socioeconomic status and treatment selection differences. 

“Future studies with longer follow-up will be needed to further characterize low-grade disease in black men and to determine the clinical significance of the small absolute differences and whether they continue to increase over time,” Dr Mahal and his colleagues concluded. 

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Mahal BA, Berman RA, Taplin ME, Huang FW. Prostate cancer-specific mortality across Gleason scores in black vs nonblack men. JAMA. 320(23).