Prostate cancer surveillance questioned for African-Americans

A study of more than 1,800 men ages 52 to 62 years suggests that African-Americans diagnosed with very low-risk prostate cancers are much more likely than Caucasian men to actually have aggressive disease that goes unrecognized with current diagnostic approaches.

Although prior studies have found it safe to delay treatment and monitor some presumably slow-growing or low-risk prostate cancers through active surveillance, such practice does not appear to be a good idea for African-American men, concluded researchers from Johns Hopkins University, Baltimore, who published their findings online in the Journal of Clinical Oncology (June 17, 2013).

“This study offers the most conclusive evidence to date that broad application of active surveillance recommendations may not be suitable for African-Americans,” said co-author Edward M. Schaeffer, MD, PhD. “This is critical information because if African-American men do have more aggressive cancers, as statistics would suggest, then simply monitoring even small cancers that are very low risk would not be a good idea because aggressive cancers are less likely to be cured. We think we are following a small, nonaggressive cancer, but in reality, this study highlights that in black men, these tumors are sometimes more aggressive than previously thought. It turns out that black men have a much higher chance of having a more aggressive tumor developing in a location that is not easily sampled by a standard prostate biopsy.”

The study also showed that the rate of increased pathologic risk, as measured by the Cancer of the Prostate Risk Assessment, was also significantly higher in African-Americans (14.8% vs. 6.9 %). Dr. Schaeffer and colleagues say their data suggest that very low-risk African-Americans have different regional distributions of their cancers and appear to also develop more high-grade cancers.

All study participants, of whom 1,473 were Caucasian and 256 African-American, met current National Comprehensive Cancer Network criteria for very low-risk prostate cancer, and were thus good candidates for active surveillance. The study showed that preoperative characteristics were similar for very low-risk Caucasians and African-Americans, although African-American men had slightly worse Charlson comorbidity index scores. Detailed analysis showed that African-American men had a lower rate of organ-confined cancers (87.9% vs. 91.0%), a higher rate of Gleason score upgrading (27.3% vs. 14.4%), and a significantly higher hazard of PSA-defined biochemical recurrence of prostate cancer.

Dr. Schaeffer said the study’s main limitation is that it is a retrospective analysis of the experience of a single academic medical center.

“The results of our study do not support the universal rejection of AS in black men, but, rather, should promote future studies to address whether alternate race-specific surveillance entry criteria should be used for African-American men to ensure oncologic parity with their white counterparts.”