Is African-America race (AAR) a risk factor for failure in prostate cancer (PCa)?

Abstract

1515 Background: There is much disagreement as to whether AAR is an independent negative risk factor in biochemical disease-free survival (BCDFS) of PCa. Much of the literature suggests that AAR is a negative risk factor of BCDFS. However, the past decade has seen improvements in treatments that may have affected outcomes in PCa. Thus, we sought to determine if AAR is an independent risk factor for BCDFS in a modern cohort of PCa patients. Methods: A retrospective review of The Columbia Urologic Oncology Database was performed. From ‘91-‘06, 2,747 patients underwent radical prostatectomy and did not receive adjunctive treatment. Of these, 252 (9%) patients were AAR, and 2495 were not of African-American Race (NAAR). Of the NAAR patients, 1,907 (69%) were Caucasian, and 588 (21%) were of other or unknown race. BCDFS was defined as time to first rise in PSA (>0.1ng/mL) or use of secondary therapy after surgery. Patients were stratified based on race (AAR vs NAAR) and year of surgery. BCDFS was evaluated using Kaplan-Meier (KM) analysis with log- rank test. Multivariate Cox regression models were fit and interaction terms were tested with Wall’s test to determine the significance of AAR on BCDFS over 3 time periods (91–95, 96–00, and 01–06). Results: The patients had a median age 61.9 yrs, pathological Gleason sum (GS) 7, and mean PSA 7.7. In KM analysis, AAR was a negative risk factor of BCDFS (p<0.01) over all time periods, had lower mean age at surgery (p<0.01), higher pre-operative PSA (p<0.01), and higher GS (p<0.01). Not surprisingly, once PSA, GS, and stage were controlled across time cohorts, AAR lost significance as a risk factor (p=0.46). When Wall’s test was used to compare the results of a multivariate analysis controlling for the same variables and stratified by time, it was found that outcomes improved over time in patients of AAR and NAAR (p<0.01), but there was no difference between the two groups (p=0.99). Conclusions: Despite previous reports that AAR is an independent negative predictor of outcome, it only appeared to be a negative risk factor in univariate analyses. Despite higher PSA, and GS, AAR was no longer a significant risk factor. Additionally, when stratified by time, patients in more contemporary cohorts had improved outcomes, with no differences between AAR and NAAR patients. No significant financial relationships to disclose.