Multi-institution analysis of racial disparity among African-American men eligible for prostate cancer active surveillance
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Michael Dinizo1, Weichung Shih2, Young Suk Kwon1, Daniel Eun3, Adam Reese3, Laura Giusto3, Edouard J. Trabulsi4, Bertram Yuh5, Nora Ruel5, Daniel Marchalik6, Jonathan Hwang6, Shilajit D. Kundu7, Scott Eggener8 and Isaac Yi Kim1
1Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
2Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NJ, USA
3Department of Urology, Temple University, Philadelphia, PA, USA
4Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
5Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
6Department of Urology, Georgetown University, Washington, DC, USA
7Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
8Section of Urology, University of Chicago, Chicago, IL, USA
Isaac Yi Kim, email: firstname.lastname@example.org
Keywords: prostate cancer; active surveillance; racial disparity
Abbreviations: AA: African-American; WA: White-American; PCa: prostate cancer; AS: active surveillance; BCR: biochemical recurrence
Received: November 06, 2017 Accepted: March 21, 2018 Published: April 20, 2018
There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African-American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003–2014 were used to assess potential racial disparity. Of the 333 (14.8%) African-American and 1923 (85.2%) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p < 0.01), pre-op PSA (5.2 v 4.7; p < 0.01), and maximum percentage cancer on biopsy (15.1% v 13.6%; p < 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed.
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