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Clin Genitourin Cancer. 2014 Oct;12(5):e189-95. doi: 10.1016/j.clgc.2014.04.003. Epub 2014 May 9.

Racial disparities in prostate cancer-specific mortality in men with low-risk prostate cancer.

Author information

1
Harvard Medical School, Boston, MA.
2
Harvard Radiation Oncology Program, Boston, MA.
3
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
4
Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
5
Department of Urology, University of California Los Angeles Medical Center, Los Angeles, CA.
6
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
7
Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT.
8
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
9
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: pnguyen@LROC.harvard.edu.

Abstract

BACKGROUND:

Men with low-risk prostate cancer (CaP) are considered unlikely to die of CaP and have the option of active surveillance. This study evaluated whether African American (AA) men who present with low-risk disease are at higher risk for death from CaP than white men.

PATIENTS AND METHODS:

The authors identified 56,045 men with low-risk CaP (T1-T2a, Gleason score ≤ 6, prostate-specific antigen ≤ 10 ng/mL) diagnosed between 2004 and 2009 using the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing-risks regression analyses were used to analyze the effect of race on prostate cancer-specific mortality (PCSM) after adjusting for known prognostic and sociodemographic factors in 51,315 men (43,792 white; 7523 AA) with clinical follow-up information available.

RESULTS:

After a median follow-up of 46 months, 258 patients (209 [0.48%] white and 49 [0.65%] AA men) died from CaP. Both AA race (adjusted hazard ratio [AHR], 1.45; 95% CI, 1.03-2.05; P = .032) and noncurative management (AHR, 1.49; 95% CI, 1.15-1.95; P = .003) were significantly associated with an increased risk of PCSM. When analyzing only patients who underwent curative treatment, AA race (AHR, 1.62; 95% CI, 1.04-2.53; P = .034) remained significantly associated with increased PCSM.

CONCLUSION:

Among men with low-risk prostate cancer, AA race compared with white race was associated with a higher risk of PCSM, raising the possibility that clinicians may need to exercise caution when recommending active surveillance for AA men with low-risk disease. Further studies are needed to ultimately determine whether guidelines for active surveillance should take race into account.

KEYWORDS:

African-American; Health Policy; Population health; Prostatic Neoplasms; SEER

PMID:
24861952
DOI:
10.1016/j.clgc.2014.04.003
[Indexed for MEDLINE]

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