Recent data from the Veterans Health Administration (VHA), an equal-access health care system, offers some reassurance that active surveillance (AS) is a reasonably safe option for Black men with low-risk prostate cancer (PCa).
Brent S. Rose, MD, of the UC San Diego Health Moores Cancer Center in La Jolla, California, and colleagues compared clinical outcomes from 2280 Black veterans (26.1%) and 6446 White veterans (73.9%) diagnosed with low-risk PCa from 2001 to 2015 and managed with AS. Black veterans were diagnosed at a younger age: median 63.2 vs 65.5 years. Investigators defined AS loosely as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy. Black and White men both had a median of 12 PSA tests and 2 biopsies with no difference in time to second biopsy.
Black patients had no increased incidence of metastasis (1.5% vs 1.4%), PCa-specific mortality (1.1% vs 1.0%), and all-cause mortality (22.4% vs 23.5%) compared with White patients, despite significantly higher 10-year disease progression (59.9% vs 48.3%) and greater receipt of definitive treatment (54.8% vs 41.4%), Dr Rose’s team reported in JAMA. Median follow-up was only 7.6 years, however, so long-term data are needed to confirm comparable metastasis and survival.
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“While improving access to care is undoubtedly beneficial, the results of this study suggest that only improving access is unlikely to completely ameliorate the disparity in pathologic outcomes,” Dr Rose and his collaborators wrote. “These data, in conjunction with the lower age at diagnosis and higher overall incidence of prostate cancer in African American men, continue to point to some underlying difference in the biology of the disease.”
The investigators also highlighted a need for better patient selection for AS, close follow-up, and timely care. “Whether protocols developed in predominantly White cohorts are appropriate for African American men remain to be evaluated,” they noted.
In an accompanying editorial, Ronald C. Chen, MD, MPH, of the University of Kansas, in Kansas City, Kansas, and colleagues agreed and emphasized rigorous implementation of AS care processes in real-world practice:
“Further reassurance would be gained from research showing similar outcomes in broader general population settings outside of the VHA context. Until such evidence is available, concerns about biologic differences in prostate cancer between Black and White men and potential disparities in receiving timely surveillance monitoring and treatment on cancer progression may continue to drive lower rates of active surveillance use among Black patients.”
Disclosure: Several study authors and editorialists declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
References
Deka R, Courtney PT, Parsons JK, et al. Association between African American race and clinical outcomes in men treated for low-risk prostate cancer with active surveillance. JAMA. 2020;324(17):1747-1754. doi:10.1001/jama.2020.17020
Shen X, Pettaway CA, Chen RC. Active surveillance for black men with low-risk prostate cancer. JAMA. 2020;324(17):1733-1734. doi:10.1001/jama.2020.16315
