Active surveillance is safe option for African American men with low-risk prostate cancer

Active surveillance can be safely used as an effective approach for African American men with low-risk prostate cancer, according to findings from a retrospective study published in JAMA.^1,2

The study investigators arrived at this conclusion when their data showed that while active surveillance raised the risk of disease progression and definitive treatment in African American men compared with non-Hispanic white men, the risk of metastasis and mortality did not increase.

“Our research provides evidence that active surveillance is safe for African American men,” senior study author Brent Rose, MD, assistant professor in the Department of Radiation Medicine and Applied Sciences at University of California San Diego School of Medicine, stated in a press release. “This means more African American men can avoid definitive treatment and the associated side effects of urinary incontinence, erectile dysfunction and bowel problems.”

The retrospective cohort study looked at data for 8726 men with low-risk prostate cancer who underwent active surveillance under the VA health care during the time period from January 1, 2001, to December 31, 2015. The final follow-up date was March 31, 2020.

The population included 2280 (26.1%) African American men and 6446 (73.9%) non-Hispanic white men. The median patient age was 63.2 years among African American patients and 65.5 years among non-Hispanic white patients.

The study investigators defined active surveillance as receiving no definitive treatment within the first year following a prostate cancer diagnosis and having 1 or more additional surveillance biopsies. The primary outcome measures used for the study were disease progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer–specific mortality, and all-cause mortality.

At a median follow-up of 7.6 years, the 10-year cumulative incidence of disease progression was 59.9% versus 48.3% (P <.001) and receipt of definitive treatment was 54.8% versus 41.4% (P <.001) among African American men versus non-Hispanic white men, respectively.

The 10-year cumulative incidence of metastasis was 1.5% versus 1.4% (P = .49) among American men versus non-Hispanic white men, respectively. The 10-year cumulative incidence of prostate cancer–specific mortality was 1.1% versus 1.0% (P = .82) and the 10-year cumulative incidence of all-cause mortality was 22.4% versus 23.5% (P = .09), in the 2 groups, respectively .

The researchers noted that, to better evaluative the mortality risk, longer-term follow-up is required.

“Physicians and patients should discuss active surveillance for African American men with low-risk prostate cancer,” Rose stated in the press release. “Overall outcomes are similar among African American men and white men. However, due to the increased risk of progression, African American men need to be carefully followed and promptly treated if their cancer progresses.”

References

1. Active Surveillance Safe for African Americans with Low-Risk Prostate Cancer. UC San Diego Health. Published online November 3, 2020. https://bit.ly/38ahuVg. Accessed November 3, 2020.

2. Deka R, Courtney PT, Parsons JK, et al. Association between African American race and clinical outcomes in men treated for low-risk prostate cancer with active surveillance. JAMA. 2020;324(17):1747-1754. doi:10.1001/jama.2020.17020