Active surveillance of prostate cancer may be risky in African Americans

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African American men who are considered to have very-low-risk prostate cancer, and who meet criteria for active surveillance, but undergo immediate surgery are much more likely than men of other races to actually have aggressive disease, according to recent findings.

Active surveillance is the preferred treatment option for men with very-low-risk prostate cancer and a life expectancy of no more than 20 years, explained Edward M. Schaeffer, MD, PhD, of The Johns Hopkins Hospital James Buchanan Brady Urological Institute in Baltimore, Maryland, and colleagues in Journal of Clinical Oncology. However, they noted, African American men are underrepresented in studies showing favorable outcomes for men with very-low-risk prostate cancer,

The team proceeded to study 256 African American men, 1,473 white men, and 72 other men who met the National Comprehensive Cancer Network criteria for very-low-risk prostate cancer and who had elected to undergo radical prostatectomy. The analysis revealed that African American men with very-low-risk prostate cancer had more adverse pathologic features at the time of surgery and poorer oncologic outcomes. These men also were more likely to experience disease upgrading at prostatectomy, positive surgical margins, and higher scores on the Cancer of the Prostate Risk Assessment Post-Surgical scoring system.

On multivariable analysis, being of African American race was an independent predictor of adverse pathologic features and pathologic upgrading, leading Schaeffer's group to conclude that African-American men with very-low-risk disease should be counseled about increased oncologic risk when deciding among their disease management options.

In a statement from Johns Hopkins Medicine, Schaeffer asserted that this study offers the most conclusive evidence to date that broad application of active surveillance recommendations may not be suitable for African Americans. “We think we are following a small, nonaggressive cancer, but in reality, this study highlights that in black men, these tumors are sometimes more aggressive than previously thought,” he added.

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