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Cancer. 2017 Nov 1;123(21):4199-4206. doi: 10.1002/cncr.30834. Epub 2017 Jun 27.

Race and risk of metastases and survival after radical prostatectomy: Results from the SEARCH database.

Author information

1
Urology Section, Veterans Affairs Medical Center, Durham, North Carolina.
2
Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
3
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
4
Urology Section, Veterans Affairs Medical Center, Augusta, Georgia.
5
Section of Urology, Department of Surgery, Medical College of Georgia, Augusta, Georgia.
6
Department of Urology, University of California at San Francisco, San Francisco, California.
7
University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
8
Division of Urology, Oregon Health & Science University, Portland, Oregon.
9
Division of Urology, University of California at San Diego School of Medicine, San Diego, California.
10
Urology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
11
Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, California.

Abstract

BACKGROUND:

Black race is associated with prostate cancer (PC) diagnosis and poor outcome. Previously, the authors reported that black men undergoing radical prostatectomy (RP) in equal-access hospitals had an increased risk of biochemical disease recurrence (BCR), but recurrences were equally aggressive as those occurring in white men. The authors examined the association between race and long-term outcomes after RP.

METHODS:

Data regarding 1665 black men (37%) and 2791 white men (63%) undergoing RP were analyzed. Using Cox models, the authors tested the association between race and BCR, BCR with a prostate-specific antigen (PSA) doubling time <9 months (aggressive disease recurrence), metastases, PC-specific death, and overall death.

RESULTS:

At a median follow-up of 102 months, 1566 men (35%) developed BCR, 217 men (5%) experienced aggressive disease recurrence, 193 men (4%) developed metastases, and 1207 men (27%) had died, 107 of whom (2%) died of PC. White men were older and had a lower preoperative PSA level, a lower biopsy and pathological grade group, and more capsular penetration but less seminal vesicle invasion and positive surgical margins versus black men (all P<.05). Black men were found to have a more recent surgery year (P<.001). On univariable analysis, black race was associated with increased BCR (P = .003) and reduced overall death (P = .017). On multivariable analysis, black race was not found to be associated with BCR (hazard ratio [HR], 1.07; P = .26), aggressive recurrence (HR, 1.14; P = .42), metastasis (HR, 1.24; P = .21), PC-specific death (HR, 1.03; P = .91), or overall death (HR, 1.03; P = .67).

CONCLUSIONS:

Among men undergoing RP at equal-access centers, although black men were found to have an increased risk of BCR, they had similar risks of aggressive disease recurrence, metastasis, and PC-specific death compared with white men, and the risk of BCR was found to be similar after controlling for risk parameters. Longer follow-up is needed to confirm these findings. Cancer 2017;123:4199-4206. © 2017 American Cancer Society.

KEYWORDS:

biochemical disease recurrence; prostate cancer; prostate cancer-specific death; prostate-specific antigen doubling time (PSADT); race; radical prostatectomy

PMID:
28654204
PMCID:
PMC5650540
DOI:
10.1002/cncr.30834
[Indexed for MEDLINE]
Free PMC Article

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