Active Surveillance for African-American Men with Prostate Cancer
Posted April 6, 2022
Brent Rose, M.D., University of California, San Diego
Many men with early prostate cancer (PCa) have slow growing tumors that may not require aggressive treatment. Standard treatment of PCa with surgery or radiation often leads to life-changing side effects, such as incontinence, bowel problems, and erectile dysfunction. Active surveillance (AS) is an appropriate method to avoid overtreatment for many men with PCa. However, whether AS is a safe option for Black men is controversial since Black men are 70% more likely to be diagnosed and 240% more likely to die from PCa than white men. Data demonstrate that Black men are predisposed to harbor more aggressive disease at diagnosis. Additionally, very few Black men have been included in AS studies and there is a need for data to better inform patients and their physicians about the safety and efficacy of AS in Black men. Dr. Brent Rose from the University of California, San Diego, sought to examine whether AS is a safe management strategy for early PCa in Black men.
Dr. Brent Rose
Through work funded by a FY17 Physician Research Award, Dr. Rose and his colleagues investigated outcomes of Black and non-Hispanic white men receiving care within the Veterans Health Administration (VHA). The VHA is an important research setting because of the rich and detailed data that can be obtained from the medical record system in addition to the diminished financial barriers to receiving medical care that are believed to play a role in health disparities. From this study, they found that Black men were not more likely to experience cancer spread to bones or other metastatic sites or to die from their cancers compared to white men. Additionally, the difference in outcomes between racial groups seen in other studies appear to be substantially diminished or eliminated within the equal access-to-care environment of the VHA. Furthermore, the team investigated the association between prostate-specific antigen velocity (PSAV), or the rate of PSA change over time, with clinical progression in this patient cohort. They found that compared to non-Hispanic white men, Black men were more likely to experience disease progression at lower PSAV thresholds, demonstrating that PSAV may be a useful clinical tool to monitor men on active surveillance, and that Black men may particularly benefit from increased frequency of PSA testing compared to white men.
From this study, Dr. Rose and his colleagues believe it is safe for some Black men to be monitored through active surveillance, ultimately helping to delay aggressive treatment and avoid unnecessary treatment side effects. This work has impacted the clinical management of prostate cancer through its recent citation in the National Comprehensive Cancer Network (NCCN) guidelines, which are the most widely utilized oncology guidelines in the United States, and can be directly discussed between physicians and patients to support informed patient decision making.
Figure 1: Cumulative incidence of all-cause mortality (A) and prostate cancer-specific mortality (B) for African
American and Non-Hispanic White men undergoing active surveillance for low-risk prostate cancer.
Nelson TJ, Javier-DesLoges J, Deka R, Courtney PT, Nalawade V, Mell L, Murphy J, Parsons JK, Rose BS. Association of Prostate-Specific Antigen Velocity With Clinical Progression Among African American and Non-Hispanic White Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA Netw Open. 2021 May 3;4(5):e219452. doi: 10.1001/jamanetworkopen.2021.9452. PMID: 33999164; PMCID: PMC8129822.
Deka R, Courtney PT, Parsons JK, Nelson TJ, Nalawade V, Luterstein E, Cherry DR, Simpson DR, Mundt AJ, Murphy JD, et al. Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA. 2020 Nov 3;324(17):1747-1754. doi: 10.1001/jama.2020.17020. PMID: 33141207; PMCID: PMC7610194.
Last updated Thursday, June 16, 2022