Assessing the Efficacy of Active Surveillance for African American Men with Low-Risk Prostate Cancer

African American men undergoing active surveillance for prostate cancer have an increased 10-year cumulative incidence of disease progression, according to a study published in JAMA.

Researchers compared the outcomes of 8,726 patients with low-risk prostate cancer (26.1% Black, 73.9% non-Hispanic white) who were diagnosed between January 2001 and December 2015 and managed with active surveillance. The researchers defined active surveillance as no definitive treatment within the first year post-diagnosis and at least one additional surveillance biopsy. The key endpoints were defined as progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer-specific mortality, and all-cause mortality. The population of interest was followed over an average of 7.6 years.

According to the results, among African American men and non-Hispanic white men, the 10-year cumulative incidence of disease progression was 59.9% versus 48.3%, respectively (difference, 11.6%, 95% confidence interval [CI], 9.2-13.9; P<0.001); receipt of definitive treatment, 54.8% versus 41.4%, respectively (difference, 13.4%; 95% CI, 11.0-15.7; P<0.001); of metastasis, 1.5% versus 1.4% (difference, 0.1%; 95% CI, –0.4 to 0.6; P=0.49); of prostate cancer-specific mortality, 1.1% versus 1.0% (difference, 0.1%; 95% CI, –0.4 to 0.6; P=0.82); and of all-cause mortality, 22.4% versus 23.5% (difference, 1.1%; 95% CI, –0.9 to 3.1; P=0.09).

The researchers wrote of the results, “African American men, compared with non-Hispanic white men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer-specific mortality. Longer-term follow-up is needed to better assess the mortality risk.”