Active Surveillance for Prostate Cancer in "Real-World" Setting: Exploring Racial Disparities
Recommended Citation
Finocchiaro A, Chiarelli G, Stephens A, Viganó S, Bertini A, Cusmano N, Guivatchian E, Dinesh A, Ficarra V, Sorce G, Briganti A, Montorsi F, Salonia A, Lughezzani G, Buffi N, Sood A, Rogers C, and Abdollah F. Active Surveillance for Prostate Cancer in "Real-World" Setting: Exploring Racial Disparities. J Racial Ethn Health Disparities 2025.
Document Type
Article
Publication Date
5-27-2025
Publication Title
J Racial Ethn Health Disparities
Abstract
INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is a safe management strategy for low-risk prostate cancer (PCa), but limited "real-world" data exist outside trial cohorts. This study investigates racial disparities in progression to treatment, upgrading, and prostate cancer-specific mortality (PCSM) in a real-world AS population, aiming to improve healthcare quality.
METHODS: We retrospectively analyzed data from the Henry Ford Health System (1995-2023) for men diagnosed with PCa (Gleason Grade ≤ 2, ≤ cT2c, N0-M0, PSA ≤ 20 ng/ml, age < 76 years) and enrolled in AS with ≥ 1 post-diagnosis PSA or biopsy and ≥ 1 year follow-up. Non-Hispanic Blacks (NHBs) and Non-Hispanic Whites (NHWs) were included. Surveillance adequacy was defined as ≥ 1 PSA/year and ≥ 1 biopsy every 4 years. Competing-risk cumulative incidence and regression assessed disparities in progression to treatment, upgrading, and PCSM.
RESULTS: Among 864 patients (38% NHBs, 62% NHWs), NHBs presented with more advanced disease, including higher rates of GG2 (29% vs. 18%, p < 0.001) and intermediate-risk PCa (39% vs. 32%, p = 0.04). Surveillance adequacy was lower in NHBs (38% vs. 50%, p < 0.001). NHBs progressed to treatment more frequently (45% vs. 36%, p < 0.001), with a 1.46-fold higher risk (95% CI: 1.14-1.87, p = 0.003). NHBs had no higher odds of upgrading but showed higher 10-year PCSM (5.6% vs. 1.4%) and 5.9-fold higher odds of PCSM (95% CI: 1.38-25.37, p = 0.01).
CONCLUSIONS: NHBs under AS face more advanced disease, lower follow-up adequacy, higher progression to treatment, and elevated PCSM odds. Targeted strategies are needed to address these disparities and improve equitable PCa care.
Medical Subject Headings
Active surveillance; Prostate-specific antigen; Prostatic neoplasms; Racial disparity
PubMed ID
40425976
ePublication
ePub ahead of print
