Pathologic and Biochemical Outcomes among African-American and Caucasian Men with Low-Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy.

Racial disparities in the incidence and risk profile of prostate cancer (PCa) at diagnosis among African-American (AA) men are well reported, however it remains unclear whether AA race is independently associated with adverse outcomes among men with clinical low risk disease.

We conducted a retrospective analysis among 895 men with clinical low risk PCa treated with radical prostatectomy within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Associations between AA versus Caucasian race with pathologic biochemical recurrence outcomes were examined using chi-square, logistic regression, log-rank, and Cox proportional hazards analyses.

We identified 355 AA and 540 Caucasian men with low-risk tumors within the SEARCH cohort followed for a median of 6.3 years. Following adjustment for relevant covariates, AA race was not significantly associated with pathological upgrade (OR 1.33, p=0.12), major upgrade (OR 0.58, p=0.10), upstaging (OR 1.09, p=0.73), or positive surgical margins (OR 1.04, p=0.81). The 5-year recurrence-free survival rates were 73.4% for AA and 78.4% for Caucasian men (log-rank p=0.18). In a Cox proportional hazards analysis model, AA race was not significantly associated with BCR (HR 1.11, p=0.52).

In a cohort of clinical low-risk patients treated with prostatectomy within an equal access health system with a high representation of AA men, we observed no significant differences in the rates of pathologic upgrade, upstage or biochemical recurrence. These data support continued use of AS in AA. Upgrading and upstaging remain concerning possibilities for all men regardless of race.

The Journal of urology. 2016 Jun 25 [Epub ahead of print]

Michael S Leapman, Stephen J Freedland, William J Aronson, Christopher J Kane, Martha K Terris, Kelly Walker, Christopher L Amling, Peter R Carroll, Matthew R Cooperberg

Helen Diller Family Comprehensive Cancer Center, Department of Urology. Electronic address: ., Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Urology, University of California Los Angeles Medical Center, Los Angeles, CA., Department of Urology, University of California San Diego Health System, San Diego, CA., Department of Urology, Georgia Regents Health System, Augusta, GA., Helen Diller Family Comprehensive Cancer Center, Department of Urology., Department of Urology, Oregon Health & Science University, Portland, OR., Helen Diller Family Comprehensive Cancer Center, Department of Urology., Helen Diller Family Comprehensive Cancer Center, Department of Urology; Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.