Five-Year Prospective Observational Study of African-American Men on Active Surveillance for Prostate Cancer Demonstrates Race Is Not Predictive of Oncologic Outcomes

Abstract

Introduction: This study aimed to evaluate if race impacted outcomes or risk of disease progression in men on active surveillance (AS) for prostate cancer. We present the results from our majority African-American cohort of men in an equal access setting over a 5-year follow-up period.

Patients and methods: All patients who elected AS for prostate cancer at the Southeast Louisiana Veterans Health Care System are entered into a prospectively managed observational database. Patients were divided into groups based on self-reported race. Grade group progression was defined as pathologic upgrading above International Society of Urological Pathology Grade Group 1 disease on subsequent biopsies following diagnostic biopsy. All tests were 2 sided using a significance of .05.

Results: A total of 228 men met inclusion criteria in the study, including 154 non-Hispanic African American and 74 non-Hispanic Caucasian American men, with a median follow-up of 5 years from the initiation of AS. Race was not predictive of Gleason grade progression, AS discontinuation, or biochemical recurrence on Cox multivariate analysis (HR = 1.01, 0.94, 0.85, P = .96, .79, .81, respectively). On Kaplan-Meier analysis at 5 years, African-American progression-free, AS discontinuation free, and overall survival probability was comparable to their Caucasian American counterparts (P > .05 for all).

Conclusions: Active surveillance is a safe treatment option for low and very low risk prostate cancer, regardless of race. African-American and Caucasian-American men did not have any significant difference in Gleason grade group progression in our cohort with 5-year follow-up.

Keywords: African American; active surveillance; health care disparities; outcomes; progression-free survival; prostate cancer.

Figure 1.

Active surveillance protocols at the SLVHCS—PSA, MRI, and DRE are performed on a scheduled basis, and biopsies are repeated every 2-3 years or for cause.

Figure 2.

(A) Kaplan-Meier curve of grade group grogression-free survival probability by race—there is no significant difference between AA and CA groups with respect to survival of grade group progression on AS. (B) Kalpan-Meier curve for discontinuing-AS-free probability by race—AA and CA men had comparable AS protocol survival.

Figure 3.

(A) Kaplan-Meier curve of grade group progression-free survival probability by NCCN risk classification—there is a significant difference between risk classification groups. Patients with NCCN very low risk disease displayed lower grade group progression-free survival than subjects diagnosed with NCCN low-risk disease. (B) Kaplan-Meier curve of grade group progression-free survival probability by race and NCCN risk classification—there is no difference between race groups adjusted for risk classification.