Increased Incidence of Pathologically Nonorgan Confined Prostate Cancer in African-American Men Eligible for Active Surveillance - 27/03/13

Doi : 10.1016/j.urology.2012.12.046

Yun-Sok Ha ^a,^b, Amirali Salmasi ^a, Michael Karellas ^a, Eric A. Singer ^a, Jeong Hyun Kim ^a,^c, Misop Han ^d, Alan W. Partin ^d, Wun-Jae Kim ^b, Dong Hyeon Lee ^e, Isaac Yi Kim ^a,^⁎
^a Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
^b Department of Urology, Chungbuk National University, Cheongju, Korea
^c Department of Urology, Kangwon National University School of Medicine, Chuncheon, Korea
^d Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD
^e Department of Urology, Ewha Woman’s University, Seoul, Korea

Reprint requests: Isaac Yi Kim, M.D., Ph.D., Section of Urologic Oncology, Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey, UMDNJ - Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903.

Abstract

Objective

To compare the clinicopathologic findings of African-American (AA) and White-American (WA) men with prostate cancer (PCa) who were candidates for active surveillance (AS) and underwent radical prostatectomy (RP).

Methods

Prospectively maintained database of men who underwent RP from 2 academic centers were analyzed retrospectively. Postoperative pathologic characteristics of patients who met the AS inclusion criteria of the University of California, San Francisco (UCSF) and National Comprehensive Cancer Network (NCCN) were evaluated. After RP, the rate of pathological upstaging and Gleason upgrading were compared between AA and WA men.

Results

In the AA cohort, 196 and 124 men met the UCSF and NCCN criteria for AS, respectively. With respect to WA patients, 191 and 148 fulfilled the AS criteria for UCSF and NCCN, respectively. AA men had a higher percentage of maximum biopsy core than WA men (15.3%-20.4% vs 11.5%-15.0%, P <.05, respectively) in both cohorts. In addition, a greater proportion of AA men had multiple positive biopsy cores compared to WA men (45.2% vs 33.1%, P = .046) under the NCCN criteria. A higher proportion of AA men were upstaged (≥pT3) compared to WA men (19.4% vs 10.1%, P = .037). A multivariate regression test revealed that age, preoperative PSA, and number of positive cores were independent predictors of more advanced disease (upstaging and/or upgrading) in AA men.

Conclusion

AA men who were candidates for AS criteria had worse clinicopathological features on final surgical pathology than WA men. These results suggest that a more stringent AS criteria should be considered in AA men with prostate cancer.

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Plan

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support:This work has been supported in part by generous grants from the Tanzman Foundation, Jon Runyan’s Score for the Cure, and by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012-0000476) and by a grant from the Next-Generation BioGreen 21 Program (No. PJ0081952011), Rural Development Administration, Republic of Korea.