African American men had a higher incidence of prostate cancer (PCa) than Caucasian men. They are 2.5 times as likely to die from prostate cancer than Caucasians. There are numerous theories about why this occurs, including genetic differences, lifestyle and nutrition, and differences in medical care or access to medical care. Experts lean toward a combination of these and other factors.
In the past 2-3 years, much more attention has been placed on offering Active Surveillance (AS) to men diagnosed with very low risk disease. A Johns Hopkins research team analyzed the follow-up prostate biopsies used to monitor AS patients for disease progression to compare rates of PCa upgrading between Caucasian and African American patients.[i]
All of the patients who began AS were diagnosed with very low risk disease, determined by the criteria of the National Comprehensive Cancer Network:
- Clinical stage < T1
- Gleason score < 6
- PSA < 10 ng/mL*
- PSA density < 0.15 ng/ML/cm3
- Less than 3 positive biopsy cores
- Cancer per core < 50%.
The results showed that African American men on AS were more likely to be reclassified to a higher grade based on biopsy results (36% vs. 16%). Even when other factors such as PSA, gland size, etc. were taken into account, race was an independent predictor, and was independently associated with reclassification by Gleason score though not by tumor volume. The authors concluded that the risk of upgrading was significantly higher for African American men. They suggest that different selection criteria might be required for African American men considering AS as a disease management strategy.
Until observed racial, ethnic and demographic differences in prostate cancer occurrence and outcomes are better understood, I encourage African American men newly diagnosed with prostate cancer to discuss this study with their doctors. In addition, getting a baseline 3T mpMRI of the prostate enables image-based monitoring of their disease as a way to know when a repeat biopsy is warranted.
For more information on AS, see the following links:
[i] Sundi D, Faisal FA, Trock BJ et al. Reclassification rates are higher among African American men than Caucasians on active surveillance. Urology. 2015 Jan;85(1):155-60.