Presentation Authors: Jeannette M. Schenk, Anna V. Faino, Lisa F. Newcomb*, Seattle, WA, James D. Brooks, Palo Alto, CA, Peter R. Carroll, San Francisco, CA, Atreya Dash, Seattle, WA, Christopher P. Filson, Atlanta, GA, Martin E. Gleave, Vancouver, Canada, Michael Liss, San Antonio, TX, Francis M. Martin, Virginina Beach, VA, Todd M. Morgan, Ann Arbor, MI, Peter S. Nelson, Seattle, WA, Ian M. Thompson, San Antonio, TX, Andrew A. Wagner, Boston, MN, Daniel W. Lin, Seattle, WA
Introduction: Recent studies have reported that African American (AA) men are at an increased risk of progression on Active Surveillance (AS) compared to Caucasians (CA). However, many of these studies are based on relatively few AA, have limited follow-up and may be subject to detection biases related to compliance with AS regimens or biopsy recommendations. The objective of this study was to evaluate whether race is associated with risk of reclassification in a well-established prospective AS cohort that utilizes protocol-driven PSA measurements and surveillance biopsies.
Methods: Data are from the multicenter Canary Prostate Active Surveillance Study (PASS). PSAs are collected every 3 months and surveillance biopsies are protocol-recommended at 6-12 months after initial diagnosis, 24 months, and every 2 years thereafter. Men included in this study had Gleason grade 3+3 or 3+4 at diagnosis, < 5 years between diagnosis and enrollment, and had undergone â‰¥ 1 surveillance biopsy. Cox proportional hazards models were used to examine differences between AA and CA men and time to reclassification, defined as an increase in Gleason score on subsequent biopsy and adverse pathology at prostatectomy, defined as pT3a or greater or Gleason grade group 3 or greater.
Results: Of the 1,315 men in this study, 89(7%) were AA and 1,226(93%) were CA. Compared to CA, AA had significantly higher median PSA and PSA density at diagnosis (5.6 vs 4.9, p < 0.001; 0.14 vs 0.11, p=0.01). Overall treatment rates were comparable between AAs and CAs, though AAs were more likely to undergo radiation and CAs were more likely to undergo radical prostatectomy (57% vs 38% and 56% vs 43%, respectively, p>0.05 for both). In multivariate models adjusted for diagnostic biopsy and clinical variables, AA race was not significantly associated with the risk of reclassification (HR=1.16, p=0.45). Among men who had a prostatectomy, the rate of adverse pathology was similar for AA and CA (31% vs 27%, p=0.76).
Conclusions: In a prospective cohort of men on AS who follow a standardized protocol of regular PSA and biopsy, AA race was not associated with risk of adverse pathologic reclassification or adverse pathology at prostatectomy. These results provide support for the choice of AS for AA men and suggest that biases related to racial disparity in screening, access to care, and patterns of treatment may contribute to conflicting results from prior studies.
Source of Funding: Canary Foundation; DoD W81XWH1410595