[Skip to Navigation]
[Skip to Navigation Landing]
Original Investigation
November 3, 2020

Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance

Author Affiliations
  • 1VHA San Diego Health Care System, La Jolla, California
  • 2Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
  • 3Department of Urology, University of California San Diego School of Medicine, La Jolla
  • 4Department of Radiation Oncology, Harvard Medical School, Cambridge, Massachusetts
  • 5Dana-Farber Cancer Institute, Harvard Medical School, Cambridge, Massachusetts
  • 6Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 7Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla
JAMA. 2020;324(17):1747-1754. doi:10.1001/jama.2020.17020
Key Points

Question  Is active surveillance a safe and effective option for African American men with low-risk prostate cancer?

Findings  In this retrospective cohort study that included 8726 men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression (59.9% vs 48.3%) and definitive treatment (54.8% vs 41.4%), but not metastasis (1.5% vs 1.4%) or prostate cancer–specific mortality (1.1% vs 1.0%).

Meaning  Among African American men with low-risk prostate cancer, active surveillance was associated with increased risk of disease progression and definitive treatment compared with non-Hispanic White men, but not increased mortality; however, longer-term follow-up is needed to better understand mortality risk.

Abstract

Importance  There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men.

Objective  To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance.

Design, Setting, and Participants  Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020.

Exposures  Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy.

Main Outcomes and Measures  Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer–specific mortality, and all-cause mortality.

Results  The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, –0.4% to 0.6%]; P = .49); of prostate cancer–specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, –0.4% to 0.6%]; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, –0.9% to 3.1%]; P = 0.09).

Conclusions and Relevance  In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer–specific mortality. Longer-term follow-up is needed to better assess the mortality risk.

×