Active surveillance for prostate cancer in a real-world setting: Exploring racial disparities in progression to treatment
Recommended Citation
Finocchiaro A, Stephens A, Bertini A, Vigano S, Cusmano NB, Dinesh A, Guivatchian E, Mssika A, Robinson B, Chiarelli G, Lughezzani G, Buffi NM, Montorsi F, Briganti A, Salonia A, Di Trapani E, Ficarra V, Sood A, Rogers C, Abdollah F. Active surveillance for prostate cancer in a real-world setting: Exploring racial disparities in progression to treatment. Eur Urol 2025; 87(S1):829.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Although it is well established that low-risk prostate cancer (PCa) can be safely managed with active surveillance (AS), there is still scarcity of “real-world” data outside trial cohorts that address the outcomes of these patients. Most series available are based on cohorts enrolled in strict surveillance protocols in high-volume centers. This study investigates the disparities between races in the progression to treatment and prostate cancer-specific mortality (PCSM) in a real-world AS population, aiming to advise and improve healthcare quality. Materials & Methods: We retrospectively analyzed data from the Henry Ford Health System, between 1995 and 2023. Eligible patients were men aged s76 years with PCa (Gleason Grade 1 or 2, scT2c, N0-M0, PSA s20 ng/ml) enrolled in AS, with at least one post-diagnosis PSA test or biopsy and a minimum follow-up of 1 year. To evaluate racial disparities, we excluded all the patients who were Non-Hispanic Blacks (NHBs) and Non-Hispanic Whites (NHWs). Demographic, socioeconomic, clinical, and surveillance intensity variables were extracted for each patient. Adequate AS follow-up was defined as at least 1 PSA/year and 1 biopsy every 4 years. Our main endpoint was to evaluate the progression to treatment; the secondary endpoint was PCSM. Cumulative incidence function (CIF) was used to assess the progression to treatment and PCSM rates over the two groups. Multivariable competing-risk regression was used to assess the progression to treatment and PCSM ratios. Results: Among the 864 patients, 38% were NHBs, and 62% were NHWs. NHBs presented with more advanced disease, showing higher rates of GG 2 (29% vs. 18%, p<0.001), intermediate-risk PCa (39% vs. 32%, p=0.04), and elevated PSA levels (5.6 ng/mL vs. 5.0 ng/mL, p<0.001). Over a median FU of 3.8 years, adequate AS follow-up rates were significantly lower among NHBs compared to NHWs (38% vs. 50%, p<0.001) and NHBs had higher rates of progression to treatment (45% vs. 36%, p<0.001). At CIF, NHBs showed higher PCSM rates at 10 years (5.4% vs. 1.4%, p=0.01) than NHWs but no differences in progression to treatment (p=0.2). At competing risk analysis, NHBs had a 1.32 higher risk of progression to treatment (HR 1.32, 95% CI: 1.03-1.68, p=0.02) than NHWs, with NHBs having a 5.9 higher risk of PCSM than NHWs (HR 5.91, 95% CI: 1.38-25.37, p=0.01). Conclusions: This study highlights significant racial disparities in disease presentation and outcomes for PCa patients under AS in the United States. NHBs are diagnosed with more advanced diseases and receive lower adequate FU with higher rates of progression to treatment. This is interestingly associated with higher PCSM rates, probably due to more aggressive disease and less FU adequacy. These findings underscore the need for targeted strategies to reduce racial disparities and improve the management of AS in PCa patients.
Volume
87
Issue
S1
First Page
829
