Study Shows Active Surveillance Not Associated with Higher Mortality in Black Men with Prostate Cancer

Black men with low-risk prostate cancer who were on active surveillance had an increased risk for disease progression and definitive treatment compared with their non-Hispanic White counterparts, but not increased mortality, according to the results of a recent study (Deka R, et al. JAMA. 2020;324:1747-1754).

Overtreatment of patients with early-stage prostate cancer is a widely recognized problem. Most patients with low-risk prostate cancer do not benefit from immediate aggressive treatment in terms of prolonging survival. In addition, overtreatment of early-stage prostate cancer is associated with high healthcare costs and negative short- and long-term effects on patients’ quality of life.

Because low-risk prostate cancer is typically a slow-growing disease, many patients do not need to be treated immediately, and can instead be monitored under an active surveillance approach. Rishi Deka, PhD, Postdoctoral Scholar, Radiation Medicine and Applied Science, University of California San Diego, and colleagues conducted a retrospective cohort study to determine whether active surveillance was a safe and effective option for Black men with low-risk prostate cancer.

The cohort included 8726 men, including 2280 Black men (median age, 63.2 years) and 6446 non-Hispanic White men (median age, 65.5 years) who were diagnosed with low-risk prostate cancer between 2001 and 2015 and who were managed with active surveillance. The median follow-up was 7.6 years.

The researchers reported that the 10-year cumulative incidence of disease progression was significantly higher in the Black cohort compared with the White cohort (59.9% vs 48.3%, respectively). Their analysis revealed that the Black men were 30% more likely to experience disease progression, 30% more likely to experience a prostate-specific antigen level >10 ng/dL, and 40% more likely to have a Gleason score >6 after diagnosis. Black men also had a significantly higher cumulative incidence of definitive treatment at 10 years than White men (54.8% vs 41.4%, respectively). However, there was no significant difference between the 2 groups in the 10-year cumulative rates of metastasis (1.5 vs 1.4%), prostate cancer–specific mortality (1.1 vs 1.0%), and all-cause mortality (22.4 vs 23.5%) during a median 7.6 years of follow-up.

The investigators noted that the lack of difference in these longer-term outcomes suggests that Black men should not be excluded from active surveillance protocols but that a longer follow-up period is needed to better assess the mortality risk.

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