Black men are less likely than White men to receive conservative management for prostate cancer (PCa), but when they do, they are more likely to switch to definitive treatment, according to a new study.
In a study of 51,543 Black and White veterans with low- to intermediate-risk PCa who had consistent care from the Veteran Administration’s health care system, 40.0% overall received conservative management, either active surveillance (AS) or watchful waiting (WW). But Black veterans (28.8% of cohort) with low- and intermediate-risk disease were 5% and 8% less likely to receive conservative management than White veterans, respectively (P <.001 and P =.002), Ravi B. Parikh, MD, MPP, of the University of Pennsylvania in Philadelphia, Pennsylvania, and colleagues reported in JAMA Network Open.
More importantly, Black men receiving conservative management had a shorter median time from PCa diagnosis to definitive therapy: 719 vs 787 days. Black patients with low- and intermediate-risk disease receiving conservative management had a 71% and 46% greater likelihood of switching to definitive therapy within 5 years of diagnosis, respectively, compared with White veterans (both P <.001). Among the AS recipients, the likelihood of switching to definitive therapy was 53% and 56% higher for low- and intermediate-risk Black patients, respectively, compared with White patients (P <.001 and P =.03). In the WW cohort, the likelihood was 80% and 48% greater for low- and intermediate-risk Black patients, respectively (both P <.001). In contrast, factors associated with a lower likelihood of definitive therapy within 5 years included lower absolute PSA level, being married, and living in a rural area.
“The findings of this study suggest that conservative management for low-risk and intermediate-risk prostate cancer may be less durable for African American veterans compared with White veterans,” the authors wrote.
Black patients also had lower restricted mean survival time at 5 years: 1679 vs 1740 days, respectively (P <.001), Dr Parikh’s team reported.
At baseline, Black veterans were more likely than their White counterparts to have intermediate-risk disease (57.5% vs 51.7%), 3 or more comorbidities (51.3% vs 42.1%), and high disability-related or income-related needs (31.1% vs 24.7%) compared with White veterans. The investigators controlled for several socioeconomic confounders, including driving distance to providers, area-level deprivation, and income and disability status. Among the study’s limitations, the team was unable to assess PSA levels, biopsy results, or prostate volume prior to definitive therapy, or distinguish between favorable and unfavorable intermediate-risk PCa.
“Future prospective research should study the effectiveness of conservative management in African American men with low-risk and intermediate-risk prostate cancer to determine whether race-specific recommendations regarding conservative management are warranted,” Dr Parikh’s team wrote.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Parikh RB, Robinson KW, Chhatre S, et al. Comparison by race of conservative management for low-risk and intermediate-risk prostate cancers in veterans from 2004 to 2018. JAMA Netw Open. 3(9). Published online September 28, 2020. doi:10.1001/jamanetworkopen.2020.18318