From the Desk of the Associate Editor: Is Active Surveillance a Suitable Option for African American Men with Prostate Cancer?

Active surveillance (AS) provides a safe management option for men with low-risk and selected men with intermediate-risk prostate cancer. However, concerns persist that African American (AA) men pursuing AS are at increased risk of adverse clinical outcomes relative to other races. 

These investigators undertook a systematic review of studies of AA men with low-risk prostate cancer and AS. They identified eleven studies focused on pathologic features at time of surgery and five on other clinical outcomes. Further, they reviewed genetic characteristics of prostate cancer and the AA population. They did not perform meta-analyses or other quantitative data analyses. 

Of the eleven studies of pathologic outcomes (ten published), seven observed associations of AA race with increased risks of adverse pathologic features at time of surgery, including but not limited to upgrading (Gleason ≥ 7), upstaging (≥ pT3a), and positive margins. Four (three published) studies observed no associations. Of the five studies examining other clinical outcomes—including progression and incidence of active treatment—all five observed direct associations of AA race with increased risk of adverse clinical outcomes. These investigators also concluded that, currently, there are no clinically actionable genomic, molecular, or epigenetic data to inform care of AA men on AS. Limitations of these data include small AA study populations in AS studies; heterogeneous outcomes definitions; and uncertainties in the validity of applying tertiary care cohort studies to broader community practice.    

The take home point is that AA men with low-risk prostate cancer are at potentially increased risk of clinical progression while on AS compared to men of other races. While this potential (and as yet unproven) risk should not exclude appropriately selected and motivated AA men from pursuing AS, it should prompt consideration of increased vigilance in the form of prostate MRI, early (i.e. within 3 to 6 months) confirmatory biopsy, and stringent interpretations of biopsy volume progression. 

Written by: J. Kellogg Parsons, MD, MHS, a board-certified urologist and Professor of Urology who specializes in treating prostate cancer, benign prostatic hyperplasia (BPH), bladder cancer, and kidney cancer.  J. Kellogg Parsons is an expert in cryosurgery, laser surgery, robotic surgery, and magnetic resonance imaging (MRI) of the prostate, and is internationally recognized for his work in prostate disease and urologic oncology. He has published over 130 scientific research articles, edited four medical textbooks, and received research grants from the NIH/National Cancer Institute (NCI), NIH/National Institute of Diabetes and Digestive and Kidney Diseases, and Department of Defense. Dr. Parsons currently serves as a consulting editor for European Urology and European Urology Focus, and is an associate editor for Prostate Cancer and Prostatic Diseases.

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