Rishi Deka1,2, P Travis Courtney1,2, J Kellogg Parsons1,3, Tyler J Nelson1,2, Vinit Nalawade1,2, Elaine Luterstein1,2, Daniel R Cherry1,2, Daniel R Simpson1,2, Arno J Mundt2, James D Murphy1,2, Anthony V D'Amico4,5,6, Christopher J Kane3, Maria Elena Martinez7, Brent S Rose1,2,3. 1. VHA San Diego Health Care System, La Jolla, California. 2. Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla. 3. Department of Urology, University of California San Diego School of Medicine, La Jolla. 4. Department of Radiation Oncology, Harvard Medical School, Cambridge, Massachusetts. 5. Dana-Farber Cancer Institute, Harvard Medical School, Cambridge, Massachusetts. 6. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla.
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.
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.
Authors: Ryan K Berglund; Timothy A Masterson; Kinjal C Vora; Scott E Eggener; James A Eastham; Bertrand D Guillonneau Journal: J Urol Date: 2008-09-17 Impact factor: 7.450
Authors: Brandon A Mahal; Mohammed Alshalalfa; Daniel E Spratt; Elai Davicioni; Shuang G Zhao; Felix Y Feng; Timothy R Rebbeck; Paul L Nguyen; Franklin W Huang Journal: Eur Urol Date: 2019-01-22 Impact factor: 20.096
Authors: Santino Butler; Vinayak Muralidhar; Janice Chavez; Zoe Fullerton; Aman Mahal; Michelle Nezolosky; Marie Vastola; Shuang G Zhao; Anthony V D'Amico; Robert T Dess; Felix Y Feng; Martin T King; Kent W Mouw; Daniel E Spratt; Quoc-Dien Trinh; Paul L Nguyen; Timothy R Rebbeck; Brandon A Mahal Journal: N Engl J Med Date: 2019-05-23 Impact factor: 91.245
Authors: Jeffrey J Tosoian; Bruce J Trock; Patricia Landis; Zhaoyong Feng; Jonathan I Epstein; Alan W Partin; Patrick C Walsh; H Ballentine Carter Journal: J Clin Oncol Date: 2011-04-04 Impact factor: 44.544
Authors: Mark S Soloway; Cynthia T Soloway; Ahmed Eldefrawy; Kristell Acosta; Bruce Kava; Murugesan Manoharan Journal: Eur Urol Date: 2010-08-20 Impact factor: 20.096
Authors: Freddie C Hamdy; Jenny L Donovan; J Athene Lane; Malcolm Mason; Chris Metcalfe; Peter Holding; Michael Davis; Tim J Peters; Emma L Turner; Richard M Martin; Jon Oxley; Mary Robinson; John Staffurth; Eleanor Walsh; Prasad Bollina; James Catto; Andrew Doble; Alan Doherty; David Gillatt; Roger Kockelbergh; Howard Kynaston; Alan Paul; Philip Powell; Stephen Prescott; Derek J Rosario; Edward Rowe; David E Neal Journal: N Engl J Med Date: 2016-09-14 Impact factor: 91.245
Authors: Nicholas J van As; Andrew R Norman; Karen Thomas; Vincent S Khoo; Alan Thompson; Robert A Huddart; Alan Horwich; David P Dearnaley; Christopher C Parker Journal: Eur Urol Date: 2008-03-07 Impact factor: 20.096
Authors: Mark S Soloway; Cynthia T Soloway; Steve Williams; Rajinikanth Ayyathurai; Bruce Kava; Murugesan Manoharan Journal: BJU Int Date: 2007-09-10 Impact factor: 5.588
Authors: Hari T Vigneswaran; Luke Mittelstaedt; Alessio Crippa; Martin Eklund; Adriana Vidal; Stephen J Freedland; Michael R Abern Journal: Prostate Cancer Prostatic Dis Date: 2021-07-08 Impact factor: 5.554
Authors: Tyler J Nelson; Juan Javier-DesLoges; Rishi Deka; P Travis Courtney; Vinit Nalawade; Loren Mell; James Murphy; J Kellogg Parsons; Brent S Rose Journal: JAMA Netw Open Date: 2021-05-03
Authors: Lauren Folgosa Cooley; Adaeze A Emeka; Travis J Meyers; Phillip R Cooper; Daniel W Lin; Antonio Finelli; James A Eastham; Christopher J Logothetis; Leonard S Marks; Danny Vesprini; S Larry Goldenberg; Celestia S Higano; Christian P Pavlovich; June M Chan; Todd M Morgan; Eric A Klein; Daniel A Barocas; Stacy Loeb; Brian T Helfand; Denise M Scholtens; John S Witte; William J Catalona Journal: J Urol Date: 2021-09-10 Impact factor: 7.600
Authors: Yaw A Nyame; Roman Gulati; Eveline A M Heijnsdijk; Alex Tsodikov; Angela B Mariotto; John L Gore; Ruth Etzioni Journal: J Natl Cancer Inst Date: 2021-10-01 Impact factor: 11.816
Authors: Maeve Kiely; Ginger L Milne; Tsion Z Minas; Tiffany H Dorsey; Wei Tang; Cheryl J Smith; Francine Baker; Christopher A Loffredo; Clayton Yates; Michael B Cook; Stefan Ambs Journal: J Natl Cancer Inst Date: 2022-01-11 Impact factor: 13.506
Authors: Spyridon P Basourakos; Michael Tzeng; Patrick J Lewicki; Krishnan Patel; Bashir Al Hussein Al Awamlh; Siv Venkat; Jonathan E Shoag; Michael A Gorin; Christopher E Barbieri; Jim C Hu Journal: Front Oncol Date: 2021-05-28 Impact factor: 6.244
Authors: Richard M Hoffman; Sarah L Mott; Bradley D McDowell; Sonia T Anand; Kenneth G Nepple Journal: Prostate Cancer Prostatic Dis Date: 2021-06-09 Impact factor: 5.455