Risk of Pathological Upgrading and Upstaging among Men with Low-Risk Prostate Cancer Varies By Race: Results from the National Cancer Data Base

The impact of African American (AA) race on oncological outcomes for low-risk prostate cancer is unclear due to conflicting data. We sought to better understand the effect of AA race on pathological upgrading and/or upstaging at prostatectomy in men with clinically low-risk prostate cancer.

We queried the National Cancer Data Base for men with low-risk prostate cancer (clinical stage ≤T2a, Gleason score ≤6, prostate-specific antigen <10 ng/ml) treated by radical prostatectomy between 2010 and 2013. The outcomes were pathological upgrading to Gleason score >6 (primary) or Gleason score >3+4=7 (secondary) and/or upstaging (pathological T3-4 or N1 disease). The association between race and the endpoints was assessed using multivariable logistic regression. To further adjust for potential confounders, stratification, by urban residence and comorbidity score, and subgroup analyses were performed.

With adjustment for age, comorbidity, income, urban residence, T stage, prostate-specific antigen level, and percentage of positive biopsy cores, AA race conferred 1.2-fold higher odds of pathological upgrading to Gleason score >6 and/or upstaging (OR 1.2, 95%CI 1.1-1.3, p<.01). AA race also was an independent predictor of pathological upgrading to Gleason score >3+4=7 and/or upstaging (p=.03).

AA men with low-risk prostate cancer are more likely to harbor higher-risk disease, which may lead to adverse outcomes. By itself, this finding does not preclude active surveillance; however, race should be considered as men weigh the risks and benefits of active surveillance versus treatment.

The Journal of urology. 2016 Aug 28 [Epub ahead of print]

Matthew J Maurice, Debasish Sundi, Edward M Schaeffer, Robert Abouassaly

Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio., University of Texas MD Anderson Cancer Center, Department of Urology, Houston, Texas., Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, Illinois., University Hospitals Case Medical Center, Department of Urology, Cleveland, Ohio. Electronic address: .