Active surveillance (AS) is an appropriate management strategy for black men with favorable-risk prostate cancer (PCa) who adhere to a standardized protocol of regular PSA tests and biopsies, investigators reported.
The prospective, multi-institutional cohort Canary Prostate Cancer Active Surveillance Study (PASS), which included 1315 men on AS, found that black men were at no higher risk of adverse pathologic reclassification on subsequent prostate biopsies than white men, a team led by Jeannette M. Schenk, PhD, RD, a senior staff scientist at the Fred Hutchinson Cancer Research Center in Seattle reported online in The Journal of Urology. In addition, blacks who eventually underwent radical prostatectomy did not have a higher risk of adverse pathologic findings by delaying treatment.
The study supports the use of a standardized AS protocol among black men with favorable-risk PCa, Dr Schenk and her colleagues concluded.
The appropriateness of AS for black men has been unclear. Black men, who have a higher PCa incidence and mortality and increased potential for underlying aggressive disease than white men, have been underrepresented in patients cohorts demonstrating favorable AS outcomes for men with low-risk PCa, Dr Schenk’s team pointed out.
All men in Canary PASS had a PCa diagnosis within 5 years of enrollment. Men underwent PSA measurements every 3 months and clinic visits every 6 months. They also underwent ultrasound-guided confirmatory prostate biopsies from 6 to 12 months after diagnosis followed by a biopsy at 24 months after diagnosis and at 2-year intervals thereafter. The study population included 89 (7%) black men and 1226 (93%) white men. Overall, patients had a median age of 63 years. The primary outcome was disease reclassification, defined as any increase in primary or secondary Gleason grade found on subsequent biopsy. The median follow-up among men with no pathologic reclassification was 3.9 years.
Overall, the study demonstrated no difference in reclassification-free survival between black and white men. Black race was not significantly associated with reclassification risk after adjusting for diagnostic biopsy and clinical variables.
With regard to study limitations, the authors noted that although the number of black men in their study is the largest to date, it is still modest and the number of black men who underwent surgery is small. Consequently, their findings should be interpreted cautiously, they noted.
The investigators acknowledged potential sources of bias that might impact associations between black race and outcomes in AS studies. They pointed out that racial disparity in the intensity of surveillance (such as the frequency of PSA tests and biopsies), or how surveillance is conducted (such as whether biopsies included the use of multiparametric magnetic resonance imaging), and differences in pathologic review could impact the likelihood of detecting progression events on AS. The investigators found no indication of these biases in their cohort.
Schenk JM, Newcomb LF, Zheng Y, et al. African American race is not associated with risk of reclassification during active surveillance: Results from the Canary Prostate Cancer Active Surveillance Study (PASS) [published online October 25, 2019). J Urol.