Twisha Chakravarty, MD, Karen Hoffman, MD, Lawrence Levy, MS, Tj Pugh, MD, Sean McGuire, MD, Seungtaek Choi, MD, Steven Frank, MD, Andrew Lee, MD, Deborah Kuban, MD, Usama Mahmood, MD; Department of Radiation Oncology, UT Medical Branch; Department of Radiation Oncology, UT MD Anderson Cancer Center
PURPOSE/OBJECTIVES: Previous studies have demonstrated that the clinical presentation of prostate cancer varies according to race. Nonetheless, it is unclear whether rates of pathologic upgrading and/or upstaging vary according to race after accounting for factors at clinical presentation. Such variation could potentially impact management decisions.
MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all men diagnosed with low-risk or very-low-risk (per the National Comprehensive Cancer Network [NCCN] definition) adenocarcinoma of the prostate who underwent prostatectomy in 2010 or 2011. Multivariable analyses were performed to determine predictors of pathologic upgrading (increase in total Gleason score) and pathologic upstaging (presence of extraprostatic extension or seminal vesicle invasion) at the time of prostatectomy. Both patient demographic (age, race) and clinical factors (T stage, Gleason score, prostate-specific antigen [PSA], number of positive cores, and number of examined cores) were included in the analyses.
RESULTS: A total of 10,620 patients were identified, of whom 3,650 (34%) had very-low-risk disease. Median age for the entire cohort was 60 years; 7,717 (73%) patients were white, 1,251 (12%) were black, 1,023 (10%) were Hispanic, 441 (4%) were Asian, and 188 (2%) were Native American/unknown race. In total, 4,511 (42%) patients had pathologic upgrading, and 992 (9%) had pathologic upstaging at the time of prostatectomy. Among the entire cohort, increasing age at diagnosis, increasing PSA, increasing number of positive cores, and decreasing number of examined cores were all significant predictors of the presence of both pathologic upgrading and pathologic upstaging on multivariable analyses (all P < .001). On the other hand, race was not found to be a significant predictor of pathologic upgrading (P = .089) or pathologic upstaging (P = .522). Similar findings were noted among patients with very-low-risk disease, with race once again not found to be a significant predictor of pathologic upgrading (P = .068) or pathologic upstaging (P = .410).
CONCLUSIONS: Our analysis of this large, population-based database demonstrates that after accounting for other demographics and clinical factors at diagnosis, race does not predict for pathologic upgrading or pathologic upstaging at the time of prostatectomy among patients with low-risk prostate cancer. As such, race by itself should not be used to select potential candidates for active surveillance or treatment.
Proceedings of the 97th Annual Meeting of the American Radium Society — americanradiumsociety.org