AUA 2018: Active Surveillance of Prostate Cancer in African Americans during the MRI Era

San Francisco, CA ( Active surveillance has received relatively widespread uptake. However, uptake has been slower in the United States than in many other Western countries. One of the reasons for this may relate to the fear of undiagnosed aggressive disease. As African American men are more likely to have adverse pathologic findings at the time of radical prostatectomy and increased rates of biochemical recurrence after RP, urologists may be wary of the risk of aggressive disease in these men. Such concern may however expose these men to a greater risk of over treatment. In a podium presentation at the American Urologic Association Annual Meeting, Dr. Bloom and colleagues examined the role the AS in African-American men undergoing MRI-fusion biopsy. 

Using their institutional, prospectively-maintained database, the authors identified all men who underwent MRI-guided fusion biopsy between 2007 and 2016 and subsequently went on to active surveillance. Patients with Gleason Grade Group 1 or 2 were included. The AS protocol for these men included annual PSA, DRE, and MRI with biopsy performed where warranted by clinical circumstances. 

The authors identified 289 eligible men, of whom 33 (11%) were African-American. Men were followed for a median of 27 months. African American men were younger than their non- African American counterparts at the initiation of AS (59 vs 63 years, p=0.004). However, PSA (7.5 vs 6.0, p=0.07), number of MRI visible lesions (2.15 vs 2.20, p=0.85), largest lesion size (1.2 vs 1.2cm, p=0.91), percentage biopsy core involved (11 vs 13%, p=0.42) and percentage Gleason Grade Group 2 (21 vs 28%, p=0.43) did not significantly differ. Additionally, unlike prior reports, there was no difference in the rates of anterior tumors. 

Pathological upgrading occurred at a similar rate in African-American men (median time 57 months) and non-African American men (63 months; p=0.4). 

As this report comes from a single, referral center, referral patterns and biases need to be considered. 

The authors conclude that, while African American men present at a younger age, tumor characteristics are similar to non-African American men and rates of upgrading are similar while on AS. Thus, AS is a reasonable option for African American men, in the context, when fusion biopsy is performed. 

Presented By: Jonathan B. Bloom 
Co-authors: Sam Gold, Graham Hale, Kareem Rayn, Joseph Baiocco, Sherif Mehralivand, Vladimir Valera, Clayton Smith, Marcin Czarniecki, Sam Gold, Bradford J. Wood, Howard L. Parnes, Peter L. Choyke, Baris Turkbey, Peter A. Pinto 

Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA