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Comparative Study
. 2020 Nov 3;324(17):1747-1754.
doi: 10.1001/jama.2020.17020.

Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance

Rishi Deka  1   2 , P Travis Courtney  1   2 , J Kellogg Parsons  1   3 , Tyler J Nelson  1   2 , Vinit Nalawade  1   2 , Elaine Luterstein  1   2 , Daniel R Cherry  1   2 , Daniel R Simpson  1   2 , Arno J Mundt  2 , James D Murphy  1   2 , Anthony V D'Amico  4   5   6 , Christopher J Kane  3 , Maria Elena Martinez  7 , Brent S Rose  1   2   3
Affiliations
Comparative Study

Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance

Rishi Deka et al. JAMA. .

Abstract

Importance: There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men.

Objective: To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance.

Design, setting, and participants: Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020.

Exposures: Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy.

Main outcomes and measures: Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer-specific mortality, and all-cause mortality.

Results: The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .49); of prostate cancer-specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, -0.9% to 3.1%]; P = 0.09).

Conclusions and relevance: In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer-specific mortality. Longer-term follow-up is needed to better assess the mortality risk.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Courtney reported receiving grants from the National Institutes of Health (NIH). Dr Parsons reported receiving personal fees from Insightec and Endocare outside the submitted work. Dr Murphy reported receiving personal fees from Boston Consulting Group outside the submitted work. Dr Kane reported owning stock in Stratify Genomics, which is a company with a prostate cancer screening product. Dr Rose reported receiving grants from the Department of Defense. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Active Surveillance Cohort Flow Chart
Figure 2.
Figure 2.. Cumulative Incidences of Selected Outcomes
A, The median years of follow-up were 5.82 (interquartile range [IQR], 3.66-8.47) for African American men and 6.50 (IQR, 4.22-9.08) for non-Hispanic White men (Wilcoxon P < .001). B, The median years of follow-up were 5.37 (IQR, 2.85-7.32) for African American men and 6.02 (IQR, 3.48-8.62) for non-Hispanic White men (Wilcoxon P < .001). C, The median years of follow-up were 7.45 (IQR, 5.66-9.58) for African American men and 7.62 (IQR, 5.67-9.91) for non-Hispanic White men (Wilcoxon P = .11). D, The median years of follow-up were 7.48 (IQR, 5.67-9.62) for African American men and 7.62 (IQR, 5.69-9.95) for non-Hispanic White men (Wilcoxon P = .14). E, The median years of follow-up were 7.48 (IQR, 5.67-9.62) for African American men and 7.62 (IQR, 5.69-9.95) for non-Hispanic White men (Wilcoxon P = .12).
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References

    1. Sundi D, Ross AE, Humphreys EB, et al. . African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy. J Clin Oncol. 2013;31(24):2991-2997. - PMC - PubMed
    1. Mahal BA, Alshalalfa M, Spratt DE, Davicioni E, Zhao SG, Feng FY, et al. . Prostate cancer genomic-risk differences between African American and White men across Gleason Scores. Eur Urol. 2019;75(6):1038-1040. - PubMed
    1. Mahal BA, Berman RA, Taplin ME, Huang FW. Prostate cancer-specific mortality across Gleason scores in black vs nonblack men. JAMA. 2018;320(23):2479-2481. - PubMed
    1. Mahal BA, Butler S, Franco I, et al. . Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United States, 2010-2015. JAMA. 2019;321(7):704-706. - PMC - PubMed
    1. Odom BD, Mir MC, Hughes S, et al. . Active surveillance for low-risk prostate cancer in African American men. Urology. 2014;83(2):364-368. - PubMed

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