AUA 2022: Racial Disparities in Rates of Gleason Grade Reclassification in a Multi-Institutional Prostate Cancer Active Surveillance Cohort: A Pennsylvania Urology Regional Collaborative (PURC) Analysis

( In a podium presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Reddy discussed racial disparities in Gleason grade reclassification among patients undergoing active surveillance in the Pennsylvania Urology Regional Collaborative (PURC).

Active surveillance is an established and guideline-recommended treatment approach for men with low-risk prostate cancer, with favorable long-term oncologic outcomes. However, to date, there is evidence that African-American (AA) men have not just a higher incidence of prostate cancer but more aggressive tumors. Thus, there have been concerns regarding the safety of active surveillance in these men. To address this, the authors sought to analyze a prospectively maintained multi-institutional AS database to compare Gleason grade reclassification rates on confirmatory biopsy stratified by race.

They utilized the Pennsylvania Urological Regional Collaborative (PURC), a prospectively maintained prostate cancer quality improvement collaborative. In this context, they identified men with low-risk disease and stratified them by race in AA vs Caucasian/Other. The primary study outcome was the rate of Gleason grade reclassification at the time of confirmatory biopsy.

The authors identified 536 patients with low risk prostate cancer treated with active surveillance, of whom 119 (22.2%) were AA and 417 (77.8%) were Caucasian/Other races. Apart from BMI, there were no significant differences in either patient demographics or index biopsy parameters between groups.


Despite these baseline similarities, AA men had a significantly higher rate of grade reclassification (35.3% vs 25.4%, p=0.034). In multivariable modeling, AA race was an independent predictor of grade reclassification (OR 1.82, p=0.042).


Thus, the authors conclude that currently utilized selection criteria and surveillance protocols fail to account for potential racial differences in oncologic outcomes. Thus, AA men may need alternate AS surveillance approaches potentially including adjunct studies (mpMRI, genomic studies) for accurate risk stratification and monitoring.

Presented by: Rohit Reddy, MD, BA, Temple University Hospital

Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

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