Select black men are potential candidates for prostate hemi-ablation based on radical prostatectomy histopathology for intermediate-risk prostate cancer-a multicenter SEARCH cohort study
- PMID: 39134653
- DOI: 10.1038/s41391-024-00880-6
Select black men are potential candidates for prostate hemi-ablation based on radical prostatectomy histopathology for intermediate-risk prostate cancer-a multicenter SEARCH cohort study
Abstract
Importance and objective: Partial gland ablation (PGA) is increasingly popular as a treatment for men with intermediate-risk prostate cancer (IR-PCa) to preserve functional outcomes while controlling their cancer. We aimed to determine the impact of race and clinical characteristics on the risk of upstaging (≥pT2c) and having adverse pathological outcomes including seminal vesicle invasion (SVI), extra prostatic extension (EPE) and lymph node invasion (LNI) at radical prostatectomy (RP) among men with IR disease eligible for PGA with hemi-ablation (HA).
Design: Retrospective analysis.
Setting: Multicenter.
Participants and measures: We studied patients diagnosed with unilateral IR-PCa treated with RP between 1988 and 2020 at 9 different Veterans Affairs hospitals within the SEARCH cohort. We analyzed differences in clinicopathological characteristics and outcome variables (odds of ≥pT2c and SVI, EPE and LNI) by race using multivariable logistic regression after adjusting for covariates.
Results: Among 3127 patients, 33% were African American (AA) men with unilateral IR-PCa undergoing RP. Compared to non-AA men, AA individuals were younger (61 vs. 65 years, p < 0.001), presented with a higher prostate specific antigen (PSA) category (≥10 ng/ml; 34 vs. 26%, p < 0.001), and had a lower clinical stage (p < 0.001). Among the 2,798 (89.5%) with ≥pT2c stage, AA men exhibited higher ≥ pT2c rates (93 vs. 89%, p < 0.001), primarily due to increased pT2c staging (64 vs. 57%), where upstaging beyond pT2 was lower than non-AA men (29 vs. 32%). On multivariable analysis, AA men were found to have higher odds of ≥pT2c (odds ratio [OR]: 1.39 CI, 1.02-1.88, p = 0.04), lower odds of EPE (OR: 0.73 CI, 0.58-0.91, p < 0.01) and no statistically significant associations with LNI (OR: 0.79 CI, 0.42-1.46, p = 0.45) and SVI (OR: 1 CI, 0.74-1.35, p = 0.99) compared to non-AA men. On multivariable analysis, clinical features associated with higher odds of ≥pT2c were pre-operative PSA ≥ 15 (OR = 2.07, P = 0.01) and higher number of positive cores (HPC) on biopsy (OR = 1.36, P < 0.001). Similarly, PSA ≥ 15, Gleason grade ≥3 and HPC on biopsy were associated with higher odds of SVI, EPE and LNI, respectively.
Conclusions: In men with IR-PCa undergoing RP, AA men demonstrated an overall higher likelihood of ≥pT2c with lower upstaging beyond pT2, lower likelihood of EPE and no significant difference in likelihood of SVI and LNI compared to non-AA men. These findings support select AA men to be potential candidates for PGA, such as HA. Clinical factors are predictive of higher pathological stage and adverse pathological outcomes at RP and could be considered when selecting candidates for PGA.
© 2024. The Author(s), under exclusive licence to Springer Nature Limited.
Conflict of interest statement
Competing interests: The authors declare no competing interests. Ethics approval: The study was approved by institutional review board with waiver of consent.
Similar articles
-
EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer.Eur Urol. 2014 Feb;65(2):467-79. doi: 10.1016/j.eururo.2013.11.002. Epub 2013 Nov 12. Eur Urol. 2014. PMID: 24321502
-
Comparison of MRI-Based Staging and Pathologic Staging for Predicting Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy.AJR Am J Roentgenol. 2023 Dec;221(6):773-787. doi: 10.2214/AJR.23.29609. Epub 2023 Jul 5. AJR Am J Roentgenol. 2023. PMID: 37404084 Free PMC article.
-
Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer.Cochrane Database Syst Rev. 2017 Sep 12;9(9):CD009625. doi: 10.1002/14651858.CD009625.pub2. Cochrane Database Syst Rev. 2017. PMID: 28895658 Free PMC article.
-
Prescription of Controlled Substances: Benefits and Risks.2025 Jul 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. 2025 Jul 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30726003 Free Books & Documents.
-
Persistent Prostate-Specific Antigen Following Radical Prostatectomy for Prostate Cancer and Mortality Risk.JAMA Oncol. 2025 May 1;11(5):502-510. doi: 10.1001/jamaoncol.2025.0110. JAMA Oncol. 2025. PMID: 40080000 Free PMC article.
References
-
- Eastham JA, Boorjian SA, Kirkby E. Clinically localized prostate cancer: AUA/ASTRO guideline. J Urol. 2022;208:505–7. - PubMed
-
- Marra G, Ploussard G, Ost P, De Visschere PJL, Briganti A, Gandaglia G, et al. Focal therapy in localised prostate cancer: Real-world urological perspective explored in a cross-sectional European survey. Urol Oncol. 2018;36:529 e11–e22. - PubMed
-
- van der Poel HG, van den Bergh RCN, Briers E, Cornford P, Govorov A, Henry AM, et al. Focal therapy in primary localised prostate cancer: the European Association of Urology Position in 2018. Eur Urol. 2018;74:84–91. - PubMed
-
- Polascik TJ, Tay KJ, Moul JW. Keeping an open mind about novel concepts for management of prostate cancer. Eur Urol. 2015;68:937–8. - PubMed
-
- Mouraviev V, Mayes JM, Sun L, Madden JF, Moul JW, Polascik TJ. Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer. Cancer. 2007;110:906–10. - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous