In this large population-based cohort of 1,794 men with low-risk, low-volume prostate cancer, AA race was not associated with more aggressive pathology compared with Caucasians.
Arpit Chhabra, MD, Justin Rineer, MD, Jeremy Weedon, PhD, David Schreiber, MD; State University of New York Downstate Medical Center; University of Florida Orlando Health; Department of Veterans Affairs, New York Harbor Healthcare System
INTRODUCTION: Recent studies have suggested that African-American (AA) patients with clinical low-risk prostate cancer may not be ideal candidates for active surveillance due to a higher likelihood of harboring aggressive disease. In this study, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to analyze whether race plays a role in pathological upstaging after radical prostatectomy (RP).
MATERIALS AND METHODS: This study consisted of patients in the SEER database for whom race was identified either as white or AA. Eligible men were diagnosed between 2010 and 2011 with prostate-specific antigen (PSA) < 10 ng/mL as well as cT1cN0M0, Gleason score 6 disease with adenocarcinoma in 2 or fewer cores of a ≥ 12-core biopsy, treated by RP. Detailed pathologic information regarding pathologic T stage, margin status, and primary and secondary pathologic Gleason scores were collected. Adverse pathology was characterized individually, as well as in a composite metric, which was defined as pT2 and Gleason ≥ 4 + 3; pT3a and Gleason 3 + 3 with positive margins; pT3a and Gleason ≥ 3 + 4; or pT3b–pT4 with any Gleason score. We also analyzed the Cancer of the Prostate Risk Assessment score (CAPRA-S) for each patient. Chi-square was used to characterize differences in pathological extent of disease by race. Univariate and multivariate logistic regression was used to look for potential predictors for adverse pathology. Statistical significance was defined as a P value of < .05.
RESULTS: There were a total of 1,794 patients who met the selection criteria, of whom 1,565 (87.2%) were identified as white and 229 (12.8%) were identified as AA. No statistical difference was observed between white and AA men with regard to pathological Gleason score (P = .99), pathological extent of disease (P = .34), margin status (P = .43), CAPRA-S score (P = .56), or adverse features (P = .45). On multivariate analysis, only increasing PSA and increasing age were significant predictors of adverse pathology. AA race was not predictive for adverse pathology on univariate (odds ratio [OR] = 1.19; 95% confidence interval [CI], 0.75–1.88; P = .45) or multivariate (OR = 1.43; 95% CI, 0.87–2.33; P = .16) analysis.
CONCLUSION: In this large population-based cohort of 1,794 men with low-risk, low-volume prostate cancer, AA race was not associated with more aggressive pathology compared with Caucasians.
Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org