Active surveillance for intermediate‐risk prostate cancer in African American and non‐Hispanic White men

Cancer ◽  
2021 ◽  
Author(s):  
P. Travis Courtney ◽  
Rishi Deka ◽  
Nikhil V. Kotha ◽  
Daniel R. Cherry ◽  
Mia A. Salans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Active Surveillance ◽  
White Men ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Hispanic White

scholarly journals African American Men With Very Low–Risk Prostate Cancer Exhibit Adverse Oncologic Outcomes After Radical Prostatectomy: Should Active Surveillance Still Be an Option for Them?

2013 ◽  
Vol 31 (24) ◽  
pp. 2991-2997 ◽  
Author(s):  
Debasish Sundi ◽  
Ashley E. Ross ◽  
Elizabeth B. Humphreys ◽  
Misop Han ◽  
Alan W. Partin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
White Men ◽  
Low Risk ◽  
Oncologic Outcomes ◽  
Pathologic Features ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Purpose Active surveillance (AS) is a treatment option for men with very low–risk prostate cancer (PCa); however, favorable outcomes achieved for men in AS are based on cohorts that under-represent African American (AA) men. To explore whether race-based health disparities exist among men with very low–risk PCa, we evaluated oncologic outcomes of AA men with very low–risk PCa who were candidates for AS but elected to undergo radical prostatectomy (RP). Patients and Methods We studied 1,801 men (256 AA, 1,473 white men, and 72 others) who met National Comprehensive Cancer Network criteria for very low–risk PCa and underwent RP. Presenting characteristics, pathologic data, and cancer recurrence were compared among the groups. Multivariable modeling was performed to assess the association of race with upgrading and adverse pathologic features. Results AA men with very low–risk PCa had more adverse pathologic features at RP and poorer oncologic outcomes. AA men were more likely to experience disease upgrading at prostatectomy (27.3% v 14.4%; P < .001), positive surgical margins (9.8% v 5.9%; P = .02), and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system (CAPRA-S) scores. On multivariable analysis, AA race was an independent predictor of adverse pathologic features (odds ratio, [OR], 3.23; P = .03) and pathologic upgrading (OR, 2.26; P = .03). Conclusion AA men with very low–risk PCa who meet criteria for AS but undergo immediate surgery experience significantly higher rates of upgrading and adverse pathology than do white men and men of other races. AA men with very low–risk PCa should be counseled about increased oncologic risk when deciding among their disease management options.

PSA velocity to predict clinical progression in African American and non-Hispanic White patients with low-risk prostate cancer undergoing active surveillance.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 196-196
Author(s):  
Juan Javier-Desloges ◽  
Tyler Nelson ◽  
Patrick Travis Courtney ◽  
Rishi Deka ◽  
Vinit Nalawade ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Active Surveillance ◽  
Cumulative Incidence ◽  
Low Risk ◽  
Clinical Progression ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Hispanic White

196 Background: The utility of prostate-specific antigen velocity (PSAV) to predict clinical progression in patients with localized prostate cancer (PC) on active surveillance remains unclear, and in African American (AA) patients on active surveillance remains undefined. Methods: We performed a cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure (VINCI). We identified 5296 patients diagnosed with localized prostate cancer (PC) from 2001 to 2015 managed with active surveillance. Follow-up extended through March 31, 2020. We defined low-risk PC as ISUP grade group 1 (GG1) clinical tumor stage ≤ 2A, and PSA level ≤ 10 ng/dl; and active surveillance as no definitive treatment within the first year after diagnosis with at least one additional staging biopsy after diagnostic biopsy. The primary outcome was grade progression on repeat biopsy/prostatectomy defined as GG2 or GG3. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards models were used to test associations between PSAV and outcomes. Results: The final cohort included 3919 Non-Hispanic White patients (NHW) (74%) and 1377 AA (26%) patients. GG2 progression on repeat biopsy occurred in 2062 (38.9%) patients, with a cumulative incidence (CI) of 43.2 % and GG3 progression occurred in 728 (13.7%) patients, with a CI of 18% at seven years. Fifty-four (0.8%) patients developed metastases, with a CI of 1.4% at ten years. In unadjusted analyses, compared to NHW patients, AA patients were significantly more likely to progress to GG2 (52.8% vs 39.8%, p<0.001), and GG3 (22.2% vs 16.8%, p=0.01). On MV analysis, PSAV was a significant predictor of GG2 (HR 1.32 [1.26-1.39]), GG3 (1.5 [1.40-1.62]), and metastases (1.38 [1.10-1.74]). A significant interaction term between race and PSAV indicated the need for different PSAV thresholds for AA and NHW men. Based on maximally selected rank statistics, optimal thresholds for separating outcomes were different in AA vs NHW men. (0.44 vs. 1.18). Conclusions: In this analysis of PSAV in low-risk prostate cancer patients on AS—to our knowledge, the largest to date for AA patients—we observed that PSAV is a robust predictor of upgrading on restaging biopsy as well as metastasis. Compared to NHW patients, AA patients were more likely to progress at lower values of PSAV and therefore merit close follow-up on active surveillance protocols.

Adverse Disease Features in Gleason Score 3 + 4 “Favorable Intermediate-Risk” Prostate Cancer: Implications for Active Surveillance

2017 ◽  
Vol 72 (3) ◽  
pp. 442-447 ◽  
Author(s):  
Alessandro Morlacco ◽  
John C. Cheville ◽  
Laureano J. Rangel ◽  
Derek J. Gearman ◽  
R. Jeffrey Karnes
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Intermediate Risk ◽  
Risk Prostate Cancer

Outcomes of Active Surveillance for Men with Intermediate Risk Prostate Cancer, A Population-Based Analysis

Urology ◽  
2021 ◽  
Author(s):  
Thenappan Chandrasekar ◽  
Nicholas Bowler ◽  
Adam Schneider ◽  
Hanan Goldberg ◽  
James R. Mark ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Population Based ◽  
Intermediate Risk ◽  
Risk Prostate Cancer

scholarly journals Prostate Cancer Grade and Stage Misclassification in Active Surveillance Candidates: Black Versus White Patients

2020 ◽  
Vol 18 (11) ◽  
pp. 1492-1499
Author(s):  
Lara Franziska Stolzenbach ◽  
Giuseppe Rosiello ◽  
Angela Pecoraro ◽  
Carlotta Palumbo ◽  
Stefano Luzzago ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Temporal Trend ◽  
Low Risk ◽  
Intermediate Risk ◽  
Multivariate Logistic Regression ◽  
Black Patients ◽  
Risk Prostate Cancer ◽  
Misclassification Rates ◽  
White Patients

Background: Misclassification rates defined as upgrading, upstaging, and upgrading and/or upstaging have not been tested in contemporary Black patients relative to White patients who fulfilled criteria for very-low-risk, low-risk, or favorable intermediate-risk prostate cancer. This study aimed to address this void. Methods: Within the SEER database (2010–2015), we focused on patients with very low, low, and favorable intermediate risk for prostate cancer who underwent radical prostatectomy and had available stage and grade information. Descriptive analyses, temporal trend analyses, and multivariate logistic regression analyses were used. Results: Overall, 4,704 patients with very low risk (701 Black vs 4,003 White), 17,785 with low risk (2,696 Black vs 15,089 White), and 11,040 with favorable intermediate risk (1,693 Black vs 9,347 White) were identified. Rates of upgrading and/or upstaging in Black versus White patients were respectively 42.1% versus 37.7% (absolute Δ = +4.4%; P<.001) in those with very low risk, 48.6% versus 46.0% (absolute Δ = +2.6%; P<.001) in those with low risk, and 33.8% versus 35.3% (absolute Δ = –1.5%; P=.05) in those with favorable intermediate risk. Conclusions: Rates of misclassification were particularly elevated in patients with very low risk and low risk, regardless of race, and ranged from 33.8% to 48.6%. Recalibration of very-low-, low-, and, to a lesser extent, favorable intermediate-risk active surveillance criteria may be required. Finally, our data indicate that Black patients may be given the same consideration as White patients when active surveillance is an option. However, further validations should ideally follow.

Pathologic Outcomes of Gleason 6 Favorable Intermediate-Risk Prostate Cancer Treated With Radical Prostatectomy: Implications for Active Surveillance

2018 ◽  
Vol 16 (3) ◽  
pp. 226-234 ◽  
Author(s):  
David D. Yang ◽  
Brandon A. Mahal ◽  
Vinayak Muralidhar ◽  
Marie E. Vastola ◽  
Ninjin Boldbaatar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Intermediate Risk ◽  
Risk Prostate Cancer
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