Racial/Ethnic patterns in prostate cancer outcomes in an active surveillance cohort.

Jennifer Cullen,Stephen A Brassell,James L'Esperance,Yongmei Chen,Timothy Brand,David G Mcleod,Christopher Porter

doi:10.1155/2011/234519

Abstract

Introduction. Concern regarding overtreatment of prostate cancer (CaP) is leading to increased attention on active surveillance (AS). This study examined CaP survivors on AS and compared secondary treatment patterns and overall survival by race/ethnicity. Methods. The study population consisted of CaP patients self-classified as black or white followed on AS in the Center for Prostate Disease Research (CPDR) multicenter national database between 1989 and 2008. Secondary treatment included radical prostatectomy (RP), external beam radiation therapy or brachytherapy (EBRT-Br), and hormone therapy (HT). Secondary treatment patterns and overall survival were compared by race/ethnicity. Results. Among 886 eligible patients, 21% were black. Despite racial differences in risk characteristics and secondary treatment patterns, overall survival was comparable across race. RP following AS was associated with the longest overall survival. Conclusion. Racial disparity in overall survival was not observed in this military health care beneficiary cohort with an equal access to health care.

Highlights

Concern regarding overtreatment of prostate cancer (CaP) is leading to increased attention on active surveillance (AS)
Being black was not a predictor of poorer overall survival among participants of the Center for Prostate Disease Research (CPDR) multicenter national database undergoing AS as initial followup for CaP. This finding was evident despite clear racial differences in clinical characteristics at time of CaP detection
Black men were observed to have a greater proportion of intermediate- and high-risk disease, but this finding did not translate into longer-term adverse outcomes in terms of overall survival

Summary

Introduction

Concern regarding overtreatment of prostate cancer (CaP) is leading to increased attention on active surveillance (AS). This study examined CaP survivors on AS and compared secondary treatment patterns and overall survival by race/ethnicity. Secondary treatment patterns and overall survival were compared by race/ethnicity. Despite racial differences in risk characteristics and secondary treatment patterns, overall survival was comparable across race. With respect to prostate cancer (CaP), poorer patient outcomes among black men have been attributed to more advanced disease at the time of detection, less aggressive initial treatment, lower socioeconomic status (SES), inadequate quality and access to care, and/or more aggressive biology of the disease [1,2,3,4,5,6,7,8,9,10,11,12,13,14]. Additional research has shown that once factors such as SES and treatment patterns are taken into account, observed racial disparities disappear [7, 12]

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