Race may be factor in PCa surveillance criteria

More stringent criteria may be needed for African-American men with prostate cancer when considering active surveillance for their disease, new research from The Cancer Institute of New Jersey, New Brunswick suggests.

The findings, published online in Urology (Feb. 26, 2013), found that the prevalence of advanced-stage cancer in African-American men who were considered to have low-risk prostate cancer on initial consultation but chose to undergo radical prostatectomy was nearly twice that of Caucasian men. These findings of more advanced disease suggest that the definition of low-risk prostate cancer should not be the same for African-American and Caucasian men.

Led by senior author Isaac Yi Kim, MD, PhD, a retrospective analysis was performed using data from men who underwent prostatectomy by surgeons at The Cancer Institute of New Jersey and Johns Hopkins medical institutions in Baltimore between 1997 and 2011. Out of 1,536 African-American men identified, 196 met eligibility criteria for active surveillance based on University of California, San Francisco (UCSF) guidelines, which include a PSA score of 10.0 ng/mL or less and a clinical stage T1/T2a tumor. A smaller cohort of 124 African-American men met the eligibility criteria under National Comprehensive Cancer Network (NCCN) guidelines, which include a life expectancy <10 years with a PSA <10.0 ng/mL. For comparison, 608 Caucasian men were identified, with 191 and 143 men meeting eligibility criteria under UCSF and NCCN guidelines, respectively.

Investigators found that the rate of higher grade disease in African-American men believed at first to have very low-risk prostate cancer based on the UCSF and NCCN guidelines was slightly higher (37.2%-46.0%) but not significantly different from that of Caucasian men (33.5%-39.2%). However, the risk of advanced-stage disease was almost twice as high in African-Americans (19.4%) as in Caucasians (10.1%).

A multivariate analysis also revealed that age, preoperative PSA level, and number of positive biopsy cores were independent predictors of more advanced disease in African-Americans.

"Considering these higher incidences of more advanced prostate cancer in African-American men, our findings suggest that more stringent criteria may be needed for those in this population who are considering active surveillance," Dr. Kim said. "We recommend a lower PSA cutoff and/or a single positive biopsy core be considered as inclusion criteria, although further study is needed."

The authors note limitations within the study including the lack of assessment of PSA velocity and density. They also believe that additional biomarkers and further refinement of imaging modalities are needed to better stratify the risk of those prostate cancer patients who are considering surveillance.