MP15-06 AFRICAN-AMERICAN MEN WITH LOW-RISK PROSTATE CANCER ARE CANDIDATES FOR ACTIVE SURVEILLANCE: THE WILL-ROGERS EFFECT?

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You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2016MP15-06 AFRICAN-AMERICAN MEN WITH LOW-RISK PROSTATE CANCER ARE CANDIDATES FOR ACTIVE SURVEILLANCE: THE WILL-ROGERS EFFECT? Robert Qi and Judd Moul Robert QiRobert Qi More articles by this author and Judd MoulJudd Moul More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2530AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is controversial whether African-American men (AAM) with low-risk prostate cancer (PC) should be placed on active surveillance (AS), with recent literature indicating AAM diagnosed with low-risk disease have increased risk of pathology upgrading and more rapid progression on AS. In this study, we evaluated the oncologic pathologies of AAM and Caucasian men who underwent RP to assess the suitability of AAM for AS. METHODS We retrospectively reviewed 1034 men (828 Caucasian, 175 AAM, 31 other) who underwent open RP by a single surgeon between 2004 and 2015. There were 345 Caucasian men and 58 AAM who met D'Amico criteria for low-risk PC. We excluded from analysis 2 men with low-risk pathology whose RPs were aborted. Chi-square test, Fisher's Exact test, and Wilcoxon Rank-Sum test were used for statistical analysis. RESULTS AAM with low-risk PC have lower rate of surgical upgrading and similar rates of adverse pathology compared with Caucasian men. Among men presenting with low-risk disease, 29.8% of AAM (17/57) but 44.5% of Caucasians (153/344) had disease upgrading at RP (p<0.04), despite that AAM overall were less likely to be clinically diagnosed with low-risk D'Amico criteria (33.1 vs 41.7%, p<0.05). AAM with low-risk pathology were younger than Caucasian men (median 55 vs 59 years, p<0.001) and had smaller prostate size (32 vs 35 grams, p<0.04). There were no statistically significant differences in surgical margins, seminal vesicle invasion, extracapsular extension, surgical staging, percent tumor, PSA at biopsy, or clinical staging. CONCLUSIONS AAM with pre-operative low-risk disease but who chose RP have significantly lower rates of surgical upgrading and similar adverse pathologies compared with their Caucasian counterparts. There may be a Will-Rogers effect as AAM with aggressive pathology appear more likely to be stratified into intermediate- and high-risk groups than Caucasians, leaving those AAM diagnosed with low-risk disease fully eligible for AS. This effect could be related to the changes in Gleason grading made at the 2005 International Society of Urological Pathology Consensus Conference. A prospective study of AS in AAM is critically needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e154 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Robert Qi More articles by this author Judd Moul More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...