African American Race is Not Associated with Risk of Reclassification during Active Surveillance: Results from the Canary Prostate Cancer Active Surveillance Study (PASS).

To evaluate whether African American (AA) men are at higher risk of reclassification in a large, prospective multi-institutional active surveillance (AS) cohort.

The Canary Prostate Active Surveillance Study (PASS) is a protocol-driven active surveillance cohort with pre-specified prostate-specific antigen (PSA) and surveillance biopsies regimen. Men included in this study had Gleason Grade Group 1 or 2 at diagnosis, < 5 years between diagnosis and enrollment, and had undergone ≥ 1 surveillance biopsy. Risk of reclassification, defined as an increase in Gleason score on subsequent biopsy, was compared between AA and CA using cox proportional hazards models. For the subset of men undergoing delayed prostatectomy, rates of adverse pathology, defined as pT3a or greater or Gleason Grade Group 3 or greater, were compared for AA and CA.

Of 1,315 men, there were 89 (7%) AA and 1,226 (93%) CA. There were no differences in the rate of treatment for AA and CA. In multivariate models, AA race was not associated with the risk of reclassification (HR=1.16, 95% CI: 0.78-1.72). Among 441 men who had a prostatectomy after a period of AS, rate of adverse pathology was similar for AA and CA (46% vs 47%, p=0.99).

Among men on AS who follow a standardized protocol of regular PSA and biopsy, AA men were not at increased risk of pathologic reclassification on AS or adverse pathology at prostatectomy. AS appears to be an appropriate management strategy for AA men with favorable risk prostate cancer.

The Journal of urology. 2019 Oct 25 [Epub ahead of print]

Jeannette M Schenk, Lisa F Newcomb, Yingye Zheng, Anna V Faino, Kehao Zhu, Yaw A Nyame, James D Brooks, Peter R Carroll, Matthew R Cooperberg, Atreya Dash, Christopher P Filson, Martin E Gleave, Michael Liss, Francis M Martin, Todd M Morgan, Peter S Nelson, Ian M Thompson, Andrew A Wagner, Daniel W Lin

Fred Hutchinson Cancer Research Center., University of Washington., Stanford University., University of California San Francisco., Emory University., University of British Columbia., University of Texas Health Sciences Center at San Antonio., Eastern Virginia Medical School., University of Michigan., Christus Santa Rosa Hospital Medical Center., Beth Israel Deaconess Medical Center.