Active surveillance increasing in African-Americans

Active surveillance (AS) rates among African-American men with low-risk prostate cancer tripled over a 5-year period in the United States beginning in 2010, which suggests that AS is viewed as a safe management option regardless of race.

An examination of the Surveillance, Epidemiology, and End Results (SEER) Program Prostate with Active Surveillance/Watchful Waiting (WW) Database found that AS became the favored management approach in patients with ≤2 positive cores, regardless of race, with more than half of African-American and non-African-American patients receiving AS by 2015, researchers from Brigham and Women’s Hospital, Boston, reported at the Genitourinary Cancers Symposium in San Francisco.

“It’s interesting that the rates for both black and nonblack men tripled, and by 2015, it was the most common treatment modality for both black and nonblack men. It seems as if providers... do view this as a safe treatment option for men regardless of race,” said first author Santino Butler, BA, research trainee and fourth-year medical student at Brigham and Women’s Hospital, working with Brandon Mahal, MD, and colleagues.

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The concern has been that African-American men with prostate cancer have a high risk for underlying biologically aggressive disease not apparent on initial biopsy.

“Some providers and clinicians use race as a risk stratification tool in order to make decisions about AS versus definitive treatment, with the thought in mind that if there was missed underlying disease with the biopsy, that it might be a safer route to do definitive therapy as opposed to AS,” Butler told Urology Times.

This thinking prompted the authors to look at trends in AS, since AS in the low-risk setting became part of a guideline released by the National Comprehensive Cancer Center (NCCN). In the low-risk setting, the rates of conservative management were lower with African-American men compared with non-African-American men, a difference of about 7%.

The SEER Prostate with AS/WW database identified 50,302 men, 5,218 of whom were African-American diagnosed with localized NCCN low-risk prostate cancer from 2010 to 2015. The primary endpoint was rates of AS/WW utilization over time, stratified by race and number of positive biopsy cores (≤2 vs. ≥3).

Next:The rate of AS/WW use increased from 12.6% to 36.4% among African-American men over the 6-year study periodThe rate of AS/WW use increased from 12.6% to 36.4% among African-American men over the 6-year study period (p<.001). Among non-African-American men, the rate increased from 14.8% to 43.3% (p<.001). This 7% difference may be due to provider hesitancy to treat these populations uniformly in the context of their historically disparate outcomes, Butler said.

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Among the men with ≤2 positive biopsy cores, AS/WW increased from 19.2% to 52.0% among African-American men (p<.001) and from 20.2% to 57.3% for non-African-American men (p<.001).

Men with ≥3 positive cores least likely to receive AS/WW

African-American men with ≥3 positive cores were the least likely to receive AS/WW, with only 22.9% receiving conservative management by 2015, and were also the only subgroup to experience a plateau in the rate of AS/WW use over the course of the study, after tripling between 2010 and 2013.

The rates of radical prostatectomy and radiation therapy each decreased between 2010 and 2015 for both African-American and non-African-American men.