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African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance PROSTATE CANCER AND PROSTATIC DISEASES Deka, R., Parsons, J., Simpson, D. R., Riviere, P., Nalawade, V., Vitzthum, L. K., Kader, A., Kane, C. J., Rock, C. S., Murphy, J. D., Rose, B. S. 2020

Abstract

There is concern that African-American men (AA) with low-risk prostate cancer may present with more aggressive disease and thus may not be candidates for active surveillance (AS). However, it is uncertain if poorer outcomes are due to disparities in access to medical care rather than true biological differences.Observational cohort study of patients diagnosed with low-risk PC-Gleason score =6, clinical tumor stage =2A, and prostate specific antigen (PSA) level =10-at US Department of Veterans Affairs between January 1, 2001 and October 31, 2015 and treated with radical prostatectomy. Outcomes included upgrading to Gleason Grade Group 2 (GG2), GG?=?3, PSA recurrence, pathologic tumor stage =3, positive surgical margins, and all-cause mortality.A total of 2857 men (AA: 835 White: 2022) with a median follow-up of 7.1 years. Overall, there was no significant difference between AA and White men in upgrading to GG?=?3 (RR?=?1.18, p?=?0.43), tumor stage =3 (RR?=?0.95, p?=?0.74), positive surgical margins (RR?=?1.14, p?=?0.20), PSA recurrence (SHR?=?1.26, p?=?0.06), and all-cause mortality (SHR?=?1.26, p?=?0.16). However, there was a significant increase in upgrading for AA to GG2 (RR?=?1.49, p?

View details for DOI 10.1038/s41391-020-0230-6

View details for Web of Science ID 000528293600001

View details for PubMedID 32327702