Active surveillance may be risky for African American prostate cancer patients

More stringent criteria may be needed for African American men with prostate cancer when considering active surveillance of the disease due to a higher risk of advanced stage cancer, according to a study published in the March issue of Urology. Prevalence of advanced stage cancer in African American men who were considered to have a low-risk prostate cancer on initial consultation but chose to undergo a radical prostatectomy was nearly twice that of Caucasian men, reported authors Isaac Yi Kim, MD, PhD, of The Cancer Institute of New Jersey, New Brunswick, and colleagues.

Given previous research showing more aggressive disease biomarkers in African American men, “the results of the present study suggest that the commonly used [active surveillance] strategies have a significant risk of cancer misclassification and [active surveillance] may not be as safe a treatment modality for many [African American] patients with [prostate cancer],” wrote the authors.

Kim and colleagues conducted a retrospective, multicenter analysis using data from men who underwent a radical prostatectomy between 1997 and 2011. A total of 196 and 124 African American men met criteria for inclusion based on University of California San Francisco (UCSF) and National Comprehensive Cancer Network (NCCN) guidelines for active surveillance, respectively. For Caucasian patients, 191 and 148 fulfilled surveillance criteria for UCSF and NCCN, respectively.

Results showed a higher proportion of African American men were upstaged following prostatectomy. Nearly one-fifth of African American men were upstaged, compared with 10 percent of Caucasian men.

A multivariate regression test revealed that age, preoperative prostate specific antigen (PSA), and number of positive biopsy cores were independent predictors of advanced disease in African American men.

“We recommend a lower PSA cutoff and/or a single positive biopsy core be considered as inclusion criteria, although further study is needed,” Kim said in a press release.

For more information on how MRI can help identify candidates for active surveillance among prostate cancer patients, click here.