African-American prostate cancer (PCa) patients are at an increased risk of Gleason score upgrading (GSU) after radical prostatectomy compared with patients of other races, according to a study published in International Urology and Nephrology online ahead of print.
The study, by Anup Vora, MD, of Washington Hospital Center in Washington, D.C., and colleagues examined 959 cases of low-risk PCa patients who had undergone radical prostatectomy from January 2005 to July 2012. African-American men made up 37% of the patient population.
A total of 288 (30%) patients had GSU on examination of the final pathologic specimen. Of these patients, 37.5% were African American. Compared with patients of other races, they were at 73.6% increased odds of GSU.
In addition, results showed that each one-unit increase in PSA and BMI was associated with a 4.5% and 3.6% increased likelihood of GSU, respectively.
A greater total number of positive biopsy cores, a higher percent of core involved with cancer, and increasing CAPRA (Cancer of the Prostate Risk Assessment) score were significant predictors of GSU.
Patients with these clinical parameters may harbor occult high-grade disease and should be carefully counseled on treatment decisions, the authors concluded.