African American men undergoing active surveillance for low-grade prostate cancer have overall poorer health than equivalent non-African American men despite meeting the same inclusion criteria.1
Active surveillance is an alternative strategy to surgery or radiation for men with low-grade prostate cancer and involves careful monitoring for signs of cancer progression. Studies on large populations of men from European ancestry undergoing active surveillance have been performed, but equivalent studies on African American men are lacking.
At the 2017 Genitourinary Cancer symposium researchers presented data on the first study to compare African American men to non-African American men undergoing active surveillance. They found a significant difference in the overall health of African American men compared with non-African American men at the start of the study. Higher numbers of African American men had diabetes, cardiovascular disease, erectile dysfunction, and were smokers. They also noted that African American men were less likely to be married.
The study consisted of 308 men, 131 African American and 177 non-African American. The groups did not differ significantly in age (65 years), BMI (28.4), family history of prostate cancer (22%), prior biopsy (21%), or clinical staging (87% T1c). There was also no difference in Gleason biopsy score.
African American men had higher levels of prostate-specific antigen (PSA) in the blood, lower testosterone, greater PSA density (the blood level of PSA divided by the volume of the transition zone, the interior part of the prostate that surrounds the urethra), and a greater linear length of cancer per biopsy score.
The investigators conclude that, “African American men have worse overall health and more aggressive prostate cancer features despite meeting inclusion criteria and selecting active surveillance. Further prospective study is needed to determine how these competing factors may impact long-term outcomes.”
1. Feibus AH, Haney NM, Liu J, et al. Baseline differences in characteristics of a racially diverse group of men electing active surveillance. Poster presented at: 2017 Genitourinary Cancers Symposium; February 16-18, 2017; Orlando, FL. Abstract 103.