MP51-05 RECLASSIFICATION RATES ARE HIGHER AMONG AFRICAN AMERICAN MEN THAN WHITE MEN ON ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 2014MP51-05 RECLASSIFICATION RATES ARE HIGHER AMONG AFRICAN AMERICAN MEN THAN WHITE MEN ON ACTIVE SURVEILLANCE Debasish Sundi, Oleksander Kryvenko, Jonathan Epstein, Bruce Trock, Patricia Landis, Zhaoyong Feng, Ashley Ross, H. Ballentine Carter, and Edward Schaeffer Debasish SundiDebasish Sundi More articles by this author , Oleksander KryvenkoOleksander Kryvenko More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Bruce TrockBruce Trock More articles by this author , Patricia LandisPatricia Landis More articles by this author , Zhaoyong FengZhaoyong Feng More articles by this author , Ashley RossAshley Ross More articles by this author , H. Ballentine CarterH. Ballentine Carter More articles by this author , and Edward SchaefferEdward Schaeffer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1661AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Active surveillance (AS) is a recommended management option for many men with very low risk prostate cancer (PCa). However, reported outcomes of AS are based on cohorts that under-represent African Americans (AA). Therefore, we evaluated the risk of reclassification on serial biopsy for Caucasian and AA men with very low risk PCa enrolled in a large prospective AS registry. Methods The Johns Hopkins AS registry is a prospective observational study that has enrolled 982 men since its initiation in 1994. Including only Caucasian and AA who met all National Comprehensive Cancer Network (NCCN) very low risk criteria (clinical stage ≤T1, Gleason ≤6, PSA <10 ng/ml, PSA density <0.15 ng/ml/cc, positive cores <3, percent cancer per core ≤50), we analyzed a cohort of 654 men (665 Caucasian, 45 AA). Univariate and multivariable hazard ratios for reclassification on serial biopsy (by grade or volume, by grade only, and by volume only) were computed with Cox proportional hazards models. Among 114 men who progressed to radical prostatectomy, all surgical specimens were re-reviewed by a blinded pathologist to determine grade, volume, and location of all tumor nodules. Results AA on AS were more likely than Caucasians to experience upgrading on serial biopsy (53.3% vs 36.2%, log-rank p<0.001). Adjusting for PSA, prostate size, volume of cancer on biopsy, and BMI, AA race was not associated with reclassification by volume, but AA race was an independent predictor of reclassification by grade on serial biopsy (H.R. 2.2, p=0.003). AA race was also associated with pathologic upgrading at surgery (83.3% vs 41.7%, p=0.045). Pathologic tumor volumes were significantly higher among men who experienced progression by grade on biopsy and among men who had pathologic Gleason ≥7 at radical prostatectomy. Conclusions AA with very low risk PCa followed on AS are at significantly higher risk of grade reclassification as compared to Caucasians. Therefore, if the goal of AS is selectively monitor men with low grade disease, AA men may require alternative selection criteria. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e598-e599 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Debasish Sundi More articles by this author Oleksander Kryvenko More articles by this author Jonathan Epstein More articles by this author Bruce Trock More articles by this author Patricia Landis More articles by this author Zhaoyong Feng More articles by this author Ashley Ross More articles by this author H. Ballentine Carter More articles by this author Edward Schaeffer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...