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AUA 2019

AUA 2019: African American Race is Not Associated with Reclassification During Active Surveillance: Results from the Canary Prostate Cancer Active Surveillance Study

Chicago, IL (UroToday.com) Active surveillance is the preferred standard of care for low-risk prostate cancer, however, recent studies have reported that African American men are at an increased risk of progression on active surveillance compared to Caucasians1. Many of these studies are based on relatively few African Americans, have limited follow-up, and may be subject to detection biases related to compliance with active surveillance regimens or biopsy recommendations. Dr. Lisa Newcomb and colleagues presented their results of African American patients on active surveillance as part of the Canary Prostate Cancer Active Surveillance Study (PASS). The objective of this study was to evaluate whether race is associated with risk of reclassification in a well-established prospective active surveillance cohort that utilizes protocol-driven PSA measurements and surveillance biopsies.

Patient data for this study was derived from the multicenter Canary Prostate Active Surveillance Study (PASS). The Canary PASS protocol for active surveillance is as follows:

  • PSAs are collected every 3 months
  • DREs are performed every 6 months
  • Surveillance biopsies are protocol-recommended at 6-12 months after initial diagnosis, 24 months, and every 2 years thereafter. 
  • MRIs are at the discretion of the provider
Men included in this study had Gleason grade 3+3 or 3+4 at diagnosis, < 5 years between diagnosis and enrollment, and had undergone >=1 surveillance biopsy. Cox proportional hazards models were used to examine differences between African American and Caucasian men and time to reclassification, defined as an increase in Gleason score on subsequent biopsy and adverse pathology at prostatectomy, defined as pT3a or greater or Gleason grade group 3 or greater.

Among the1,315 men in this study, 89 (7%) were African American and 1,226 (93%) were Caucasian. Compared to Caucasian men, African Americans had significantly higher median PSA (5.6 vs 4.9, p < 0.001) and PSA density (0.14 vs 0.11, p=0.01) at diagnosis. Overall treatment rates were comparable between African Americans and Caucasians, though African Americans were more likely to undergo radiation (57% vs 38%, p>0.05) and Caucasians were more likely to undergo radical prostatectomy (56% vs 43%, p>0.05). 




In multivariate models adjusted for diagnostic biopsy and clinical variables, African American race was not significantly associated with the risk of reclassification (HR 1.16, p=0.45). Among men who had a prostatectomy, the rate of adverse pathology was similar for African Americans and Caucasians (31% vs 27%, p=0.76). Differences in timing of surveillance biopsies may bias results, however Dr. Newcomb notes that compliance to protocol-directed biopsy schedule was similar among both groups.

Dr. Newcomb noted several limitations of the study, including (i) the number of African Americans was small (7%), albeit this is the largest number of African Americans on active surveillance that has been reported, and (ii) there was relatively short-term follow-up (median 3-4 years)

Several important conclusions from this study:

  • In a prospective cohort of men on active surveillance who follow a standardized protocol of regular PSA and biopsy, African American race was not associated with risk of adverse pathologic reclassification or adverse pathology at prostatectomy
  • These results provide support for the choice of active surveillance for African American men and suggest that biases related to racial disparity in screening, access to care, and patterns of treatment may contribute to conflicting results from prior studies.
Presented by: Lisa Newcomb, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA

Co-Authors:Jeannette M. Schenk, Anna V. Faino, Seattle, WA, James D. Brooks, Palo Alto, CA, Peter R. Carroll, San Francisco, CA, Atreya Dash, Seattle, WA, Christopher P. Filson, Atlanta, GA, Martin E. Gleave, Vancouver, Canada, Michael Liss, San Antonio, TX, Francis M. Martin, Virginina Beach, VA, Todd M. Morgan, Ann Arbor, MI, Peter S. Nelson, Seattle, WA, Ian M. Thompson, San Antonio, TX, Andrew A. Wagner, Boston, MN, Daniel W. Lin, Seattle, WA

Written By: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University - Medical College of Georgia @zklaassen_md at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

Reference:
  1. Gokce MI, Sundi D, Schaeffer E, Pettaway C. Is active surveillance a suitable option for African American men with prostate cancer? A systematic literature review. Prostate Cancer Prostatic Dis 2017 Jun;20(2):127-136.