Lara Franziska Stolzenbach1,2, Giuseppe Rosiello1,3, Angela Pecoraro1,4, Carlotta Palumbo1,5, Stefano Luzzago1,6, Marina Deuker1,7, Zhe Tian1, Anne-Sophie Knipper2, Raisa Pompe8, Kevin C Zorn1, Shahrokh F Shariat9,10, Felix K H Chun7, Markus Graefen2, Fred Saad1, Pierre I Karakiewicz1. 1. 1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. 2. 2Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 3. 3Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. 4Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy. 5. 5Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. 6. 6Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy. 7. 7Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. 8. 8Department of Urology, Medical University of Hamburg, Hamburg, Germany. 9. 9Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; and. 10. 10Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Abstract
BACKGROUND: Misclassification rates defined as upgrading, upstaging, and upgrading and/or upstaging have not been tested in contemporary Black patients relative to White patients who fulfilled criteria for very-low-risk, low-risk, or favorable intermediate-risk prostate cancer. This study aimed to address this void. METHODS: Within the SEER database (2010-2015), we focused on patients with very low, low, and favorable intermediate risk for prostate cancer who underwent radical prostatectomy and had available stage and grade information. Descriptive analyses, temporal trend analyses, and multivariate logistic regression analyses were used. RESULTS: Overall, 4,704 patients with very low risk (701 Black vs 4,003 White), 17,785 with low risk (2,696 Black vs 15,089 White), and 11,040 with favorable intermediate risk (1,693 Black vs 9,347 White) were identified. Rates of upgrading and/or upstaging in Black versus White patients were respectively 42.1% versus 37.7% (absolute Δ = +4.4%; P<.001) in those with very low risk, 48.6% versus 46.0% (absolute Δ = +2.6%; P<.001) in those with low risk, and 33.8% versus 35.3% (absolute Δ = -1.5%; P=.05) in those with favorable intermediate risk. CONCLUSIONS: Rates of misclassification were particularly elevated in patients with very low risk and low risk, regardless of race, and ranged from 33.8% to 48.6%. Recalibration of very-low-, low-, and, to a lesser extent, favorable intermediate-risk active surveillance criteria may be required. Finally, our data indicate that Black patients may be given the same consideration as White patients when active surveillance is an option. However, further validations should ideally follow.
BACKGROUND: Misclassification rates defined as upgrading, upstaging, and upgrading and/or upstaging have not been tested in contemporary Black patients relative to White patients who fulfilled criteria for very-low-risk, low-risk, or favorable intermediate-risk prostate cancer. This study aimed to address this void. METHODS: Within the SEER database (2010-2015), we focused on patients with very low, low, and favorable intermediate risk for prostate cancer who underwent radical prostatectomy and had available stage and grade information. Descriptive analyses, temporal trend analyses, and multivariate logistic regression analyses were used. RESULTS: Overall, 4,704 patients with very low risk (701 Black vs 4,003 White), 17,785 with low risk (2,696 Black vs 15,089 White), and 11,040 with favorable intermediate risk (1,693 Black vs 9,347 White) were identified. Rates of upgrading and/or upstaging in Black versus White patients were respectively 42.1% versus 37.7% (absolute Δ = +4.4%; P<.001) in those with very low risk, 48.6% versus 46.0% (absolute Δ = +2.6%; P<.001) in those with low risk, and 33.8% versus 35.3% (absolute Δ = -1.5%; P=.05) in those with favorable intermediate risk. CONCLUSIONS: Rates of misclassification were particularly elevated in patients with very low risk and low risk, regardless of race, and ranged from 33.8% to 48.6%. Recalibration of very-low-, low-, and, to a lesser extent, favorable intermediate-risk active surveillance criteria may be required. Finally, our data indicate that Black patients may be given the same consideration as White patients when active surveillance is an option. However, further validations should ideally follow.
Authors: Yu Jiang; Travis J Meyers; Adaeze A Emeka; Lauren Folgosa Cooley; Phillip R Cooper; Nicola Lancki; Irene Helenowski; Linda Kachuri; Daniel W Lin; Janet L Stanford; Lisa F Newcomb; Suzanne Kolb; Antonio Finelli; Neil E Fleshner; Maria Komisarenko; James A Eastham; Behfar Ehdaie; Nicole Benfante; Christopher J Logothetis; Justin R Gregg; Cherie A Perez; Sergio Garza; Jeri Kim; Leonard S Marks; Merdie Delfin; Danielle Barsa; Danny Vesprini; Laurence H Klotz; Andrew Loblaw; Alexandre Mamedov; S Larry Goldenberg; Celestia S Higano; Maria Spillane; Eugenia Wu; H Ballentine Carter; Christian P Pavlovich; Mufaddal Mamawala; Tricia Landis; Peter R Carroll; June M Chan; Matthew R Cooperberg; Janet E Cowan; Todd M Morgan; Javed Siddiqui; Rabia Martin; Eric A Klein; Karen Brittain; Paige Gotwald; Daniel A Barocas; Jeremiah R Dallmer; Jennifer B Gordetsky; Pam Steele; Shilajit D Kundu; Jazmine Stockdale; Monique J Roobol; Lionne D F Venderbos; Martin G Sanda; Rebecca Arnold; Dattatraya Patil; Christopher P Evans; Marc A Dall'Era; Anjali Vij; Anthony J Costello; Ken Chow; Niall M Corcoran; Soroush Rais-Bahrami; Courtney Phares; Douglas S Scherr; Thomas Flynn; R Jeffrey Karnes; Michael Koch; Courtney Rose Dhondt; Joel B Nelson; Dawn McBride; Michael S Cookson; Kelly L Stratton; Stephen Farriester; Erin Hemken; Walter M Stadler; Tuula Pera; Deimante Banionyte; Fernando J Bianco; Isabel H Lopez; Stacy Loeb; Samir S Taneja; Nataliya Byrne; Christopher L Amling; Ann Martinez; Luc Boileau; Franklin D Gaylis; Jacqueline Petkewicz; Nicholas Kirwen; Brian T Helfand; Jianfeng Xu; Denise M Scholtens; William J Catalona; John S Witte Journal: HGG Adv Date: 2021-11-19