Abstract

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20121333 AFRICAN AMERICAN MEN WITH LOW-RISK PROSTATE CANCER MAY HAVE INCREASED RISK OF PROGRESSION ON ACTIVE SURVEILLANCE Viacheslav Iremashvili, Mark S. Soloway, Daniel L. Rosenber, and Murugesan Manoharan Viacheslav IremashviliViacheslav Iremashvili Miami, FL More articles by this author , Mark S. SolowayMark S. Soloway Miami, FL More articles by this author , Daniel L. RosenberDaniel L. Rosenber Miami, FL More articles by this author , and Murugesan ManoharanMurugesan Manoharan Miami, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1715AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance is an established management option for patients with low-risk prostate cancer. However, little is known about the clinical and demographic characteristics associated with an increased risk of progression in active surveillance patients. We analyzed our active surveillance cohort in search of such features. METHODS Since 1994, 272 men with prostate cancer have enrolled in our active surveillance program. 249 of them had at least one surveillance biopsy and were included in the analysis. Our inclusion criteria for active surveillance are biopsy Gleason grade < 7, < 2 positive biopsy cores, < 20% tumor present in any core, and clinical stage T1-T2a. Changes in any of these parameters during the follow-up that went beyond these limits were considered to be progression. Univariate and multivariate Cox regression analyses were used to determine patient characteristics associated with increased risk of progression. RESULTS 9.6% patients are African American. 64 (26%) of all patients progressed over a median follow-up of 2.9 years (mean number of surveillance biopsies 2.3). The risk of progression was significantly higher in African American patients and in men with smaller prostates and higher prostate-specific antigen (PSA) densities (Table 1). By three years of active surveillance more than half of African American patients had biopsy progression compared to less than 25% of Caucasians (Figure 1). Neither prostate volume nor PSA density demonstrated any specific cut-points for their association with progression. Table 1. Univariate and multivariate analysis of factors associated with biopsy progression Variables Univariate Univariate Univariate Multivariate model with prostate volume1 Multivariate model with prostate volume1 Multivariate model with prostate volume1 Multivariate model with PSA density1 Multivariate model with PSA density1 Multivariate model with PSA density1 HR 95% CI p HR 95% CI p HR 95% CI p Age 1.02 0.99-1.05 0.213 Race Caucasian (reference group) African American 4.31 2.35-7.89 <0.001 3.79 2.08-6.90 <0.001 4.39 2.43-7.92 <0.001 Ethnicity Non-Hispanic (reference group) Hispanic 0.73 0.43-1.27 0.270 Obesity (BMIò30 kg/m2) 0.68 0.36-1.31 0.253 Diabetes 1.64 0.85-3.14 0.139 Hypercholesterolemia 1.54 0.80-2.96 0.196 Hypertension 1.46 0.89-2.40 0.132 Family history of prostate cancer 0.82 0.43-1.57 0.547 Negative biopsy before the diagnosis 1.27 0.69-2.34 0.440 Clinical stage T1c (reference group) T2a 1.87 0.80-4.33 0.146 Positive biopsy cores 1 (reference group) 2 2.41 1.65-3.52 <0.001 2.46 1.62-3.71 <0.001 2.67 1.78-4.00 <0.001 Prostate volume (for every 10 ml increase) 0.81 0.69-0.94 0.005 0.82 0.70-0.96 0.012 PSA 1.03 0.95-1.13 0.441 PSA density (for every 0.1 ng/ml per ml increase) 1.34 1.11-1.63 0.003 1.40 1.13-1.73 0.002 HR = hazard ratio; CI = confidence interval; PSA = prostate-specific antigen 1 = forward stepwise selection provided similar results. CONCLUSIONS African Americans with low-risk prostate cancer should be advised that their risk of progression on active surveillance may be higher than what is indicated in the literature. Integral prognostic tools incorporating race and PSA density may be useful to accurately assess the individual risk of progression in active surveillance patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e540 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Viacheslav Iremashvili Miami, FL More articles by this author Mark S. Soloway Miami, FL More articles by this author Daniel L. Rosenber Miami, FL More articles by this author Murugesan Manoharan Miami, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.