Hari T Vigneswaran1,2, Luke Mittelstaedt3, Alessio Crippa4, Martin Eklund4, Adriana Vidal5, Stephen J Freedland5,6, Michael R Abern3. 1. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA. hvignes2@uic.edu. 2. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. hvignes2@uic.edu. 3. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA. 4. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. 5. Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 6. Section of Urology, Department of Surgery, Durham VA Medical Center, Durham, NC, USA.
Abstract
BACKGROUND: Several studies evaluated prostate cancer (PCa) outcomes in Black men on active surveillance (AS); most studies contained few Black men and results were conflicting. We performed a systematic review and meta-analyze of race and outcomes on AS. METHODS: A systematic search was performed for articles of men with Grade Group 1 or 2 (GG1 or GG2) PCa on AS. All studies required race-specific comparative progression data. Progression to treatment, PSA, or biopsy progression were considered and relative risk (RR) estimates of Black men progressing were extracted and pooled using random-effects models. Differences by study-level characteristics were evaluated using subgroup and a cumulative meta-analysis by time. RESULTS: In total, 12 studies were included (3137 Black and 12,206 non-Black men); eight prospective (27%, n = 4210) and four retrospectives (73%, n = 11,133) cohorts. The overall RR of progression for Black men was 1.62 (95%CI, 1.21-2.17), I2 = 64% (95% CI, 32-80%), (χ2 = 30.23; P = 0.001; τ2 = 0.16). Black men with GG1 PCa alone had a higher pooled progression: RR = 1.81 (95% CI, 1.23-2.68). Including only studies with clinical progression (excluding progression to treatment), potentiated results: RR = 1.82 (95%CI, 1.27-2.60). However, a cumulative meta-analysis demonstrated decreasing pooled effect over time, with contemporary studies after 2019 showing a tempered effect (RR: 1.29, 95% CI: 1.20-1.39). CONCLUSIONS: Many studies attribute racial disparity in PCa to delayed presentation of disease, however, AS is unique since all AS eligible men have a low grade and stage PCa. Our findings suggest Black men may have an increased risk of progression during AS, but the association is not so strong that Black men should be discouraged from undergoing AS. Indeed, contemporary evidence suggests stricter inclusion, better confirmatory testing or better access to care may temper these findings. Importantly, these results utilize self-reported race, a social construct that has many limitations.
BACKGROUND: Several studies evaluated prostate cancer (PCa) outcomes in Black men on active surveillance (AS); most studies contained few Black men and results were conflicting. We performed a systematic review and meta-analyze of race and outcomes on AS. METHODS: A systematic search was performed for articles of men with Grade Group 1 or 2 (GG1 or GG2) PCa on AS. All studies required race-specific comparative progression data. Progression to treatment, PSA, or biopsy progression were considered and relative risk (RR) estimates of Black men progressing were extracted and pooled using random-effects models. Differences by study-level characteristics were evaluated using subgroup and a cumulative meta-analysis by time. RESULTS: In total, 12 studies were included (3137 Black and 12,206 non-Black men); eight prospective (27%, n = 4210) and four retrospectives (73%, n = 11,133) cohorts. The overall RR of progression for Black men was 1.62 (95%CI, 1.21-2.17), I2 = 64% (95% CI, 32-80%), (χ2 = 30.23; P = 0.001; τ2 = 0.16). Black men with GG1 PCa alone had a higher pooled progression: RR = 1.81 (95% CI, 1.23-2.68). Including only studies with clinical progression (excluding progression to treatment), potentiated results: RR = 1.82 (95%CI, 1.27-2.60). However, a cumulative meta-analysis demonstrated decreasing pooled effect over time, with contemporary studies after 2019 showing a tempered effect (RR: 1.29, 95% CI: 1.20-1.39). CONCLUSIONS: Many studies attribute racial disparity in PCa to delayed presentation of disease, however, AS is unique since all AS eligible men have a low grade and stage PCa. Our findings suggest Black men may have an increased risk of progression during AS, but the association is not so strong that Black men should be discouraged from undergoing AS. Indeed, contemporary evidence suggests stricter inclusion, better confirmatory testing or better access to care may temper these findings. Importantly, these results utilize self-reported race, a social construct that has many limitations.
Authors: Edward Schaeffer; Sandy Srinivas; Emmanuel S Antonarakis; Andrew J Armstrong; Justin E Bekelman; Heather Cheng; Anthony Victor D'Amico; Brian J Davis; Neil Desai; Tanya Dorff; James A Eastham; Thomas A Farrington; Xin Gao; Eric Mark Horwitz; Joseph E Ippolito; Michael R Kuettel; Joshua M Lang; Rana McKay; Jesse McKenney; George Netto; David F Penson; Julio M Pow-Sang; Robert Reiter; Sylvia Richey; Mack Roach Iii; Stan Rosenfeld; Ahmad Shabsigh; Daniel E Spratt; Benjamin A Teply; Jonathan Tward; Dorothy A Shead; Deborah A Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2021-02-02 Impact factor: 11.908
Authors: M Tsivian; L L Bañez; C J Keto; M R Abern; P Qi; L Gerber; J W Moul; T J Polascik Journal: Prostate Cancer Prostatic Dis Date: 2012-10-02 Impact factor: 5.554
Authors: Fritz H Schröder; Jonas Hugosson; Monique J Roobol; Teuvo L J Tammela; Stefano Ciatto; Vera Nelen; Maciej Kwiatkowski; Marcos Lujan; Hans Lilja; Marco Zappa; Louis J Denis; Franz Recker; Antonio Berenguer; Liisa Määttänen; Chris H Bangma; Gunnar Aus; Arnauld Villers; Xavier Rebillard; Theodorus van der Kwast; Bert G Blijenberg; Sue M Moss; Harry J de Koning; Anssi Auvinen Journal: N Engl J Med Date: 2009-03-18 Impact factor: 91.245
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: Ronald C Chen; R Bryan Rumble; D Andrew Loblaw; Antonio Finelli; Behfar Ehdaie; Matthew R Cooperberg; Scott C Morgan; Scott Tyldesley; John J Haluschak; Winston Tan; Stewart Justman; Suneil Jain Journal: J Clin Oncol Date: 2016-02-16 Impact factor: 44.544