Active surveillance for prostate cancer in real-world setting: Exploring racial disparities in surveillance intensity and cancer control outcomes

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Black men have worse outcomes from prostate cancer (PCa) compared to White men. This is, at least partially, due to the racial disparity and health care delivery. Our aim was to evaluate the impact of race on surveillance intensity and Prostate Cancer Specific Mortality (PCSM) in patients on AS for PCa in a contemporary, real-world North American cohort. Materials & Methods: We utilized our institutional database which was built by interrogating our electronic medical records for all men who got diagnosed with PCa. Our cohort included White and Black men aged < 76 years, who had a diagnosis of Pca Gleason Grade (GG) 1 or 2, with clinical stage ≤cT2b, with PSA≤20 ng/ml, enrolled on AS following a diagnosis before 2022. This allows one year's worth of eventual treatment information in our database. Cumulative incidence was used to depict PCSM by race. Multivariable Fine-Gray regression analysis (MVA) was used to examine the impact of race in predicting PCSM in AS patients, after accounting for all confounders including the Charlson comorbidity index (CCI), among others. Results: A total of 1068 men met the inclusion criteria, of whom 443 (42%) were Black and 625 (58%) were White, with a median age at diagnosis of 65 (IQR 58-69) and 66 (60-70), respectively. CCI>2 was reported in 44.1% of Black patients and 31.2% of White patients (p<0001). Median PSA at diagnosis was 5.7 (4.6-8.0) ng/ml in Black patients and 5.0 (4.0-6.6) ng/ml in White patients (p<0.0001). The rate of GG 2 was higher in Black than in White patients (43,6% vs 30.1%, p<0.0001). Follow-up time was 6 years (2.5-9.6). Median PSAs testing/years after diagnosis was 1.4 (0.6-2.5) for Black patients and 1.6 (0.6-3.2) for Black patients (p<0.05). The rate of patients who underwent more than one biopsy after diagnosis was 14.6% of Black and 22.6% of White patients (p<0.001). In the overall period, PCSM was 4.1% in Black and 1.6% in White patients (p<0.01). The cumulative incidence of PCSM at 10 years was double for Black patients compared to White patients (5.2% vs 2.6% CI 95%, p=0.0502). At MVA Black patients had 2.1 folds higher PCSM than White patients (p=0.08). Conclusions: Black patients on AS tend to have more aggressive disease at diagnosis and seem to undergo less PSA testing and postdiagnosis biopsies. This might, at least partially, be explained by higher PCSM in Black patients on AS that we observed in our cohort. Our report is one of few examining the intensity and outcomes of AS in real-world practice with a focus on racial disparities.

Volume

85

First Page

S1817

Last Page

S1817

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