Almost all statistics point to a greater occurrence of prostate cancer (PCa) among African American men than Caucasian men. According to national data, black men are 1.6 times more likely to be diagnosed with prostate cancer and 2.4 times more likely to die from it. This is thought to be because of a mix of factors that includes socioeconomics, lifestyle and nutritional habits, differences in medical care, and possibly unknown genetic factors. With such sobering demographic patterns, black men with low-risk PCa and their doctors may opt for immediate prostatectomy (RP) rather than Active Surveillance (AS).
However, clinical factors may matter more than population data. I came across a 2015 study that set up a side-by-side comparison of black and white men originally diagnosed with low-risk, low-volume PCa who were treated by RP to see if the surgical specimens of the black men showed more features of aggressive PCa than those of the white men.[i] The authors identified 1794 cases of black and white men (2010-2011) whose pre-surgery diagnosis included features that generally qualify patients for AS:
- Gleason 6 (3+3)
- PSA < 10 ng/mL
- Less than or equal to 2 positive needles out of a 12 core biopsy
- Stage less than or equal to T1c
In this study group, all of the men chose surgery rather than AS. The lab results of examining the post-surgery specimens are called “histopathology.” As you may know, histopathology frequently reveals PCa traits that were missed by the biopsy, such as higher Gleason score (upgrading) of the cancer. The study authors defined unfavorable histopathology features as
- Gleason greater than or equal to 4+3 with stage T2 or
- Gleason 3+3 with stage T3a and positive margins, or
- Gleason greater than or equal to 3+4 with stage T3a, or
- Any Gleason score with stage T3b-T4
What do you think they found? There were NO statistically significant differences between African American and Caucasian men regarding Gleason score, extent of disease, positive margins and Cancer of the Prostate Risk Assessment score.
Thus, African American men with low-risk, low-volume PCa were found to have no more aggressive PCa features than their Caucasian counterparts who all had the same initial diagnosis. While this study sheds no light on why there appears to be a higher incidence of PCa among black men, it’s good news. In finding no evidence of a more aggressive PCa nature among black men, the authors wrote that their data support AS among black men with low-risk, low-volume prostate cancer.
[i] Schreiber D, Chhabra A, Rineer J et al. A population-based study of men with low-volume low-risk prostate cancer: Does African-American race predict for more aggressive disease? Clin Genitourin Cancer. 2015 Feb 21. Doi: 10.1016/j.clgc.2015.02.006