Assessing Untreated Localized Prostate Cancer Among Different Ethnic Groups

For men with untreated localized prostate cancer, there is a significant risk of disease spread and mortality beyond 10 years, but these risks are not equally distributed among racial groups, according to a study published in Cancer Medicine.

Approximately 80% of prostate cancers (PCas) are diagnosed at the localized stage, and an increasing number of men with localized PCa opt for surveillance over curative treatments, which may cause adverse side effects such as incontinence and sexual dysfunction. Researchers noted that because men with localized PCa usually live a long time, it’s important to study this population. However, most studies have included single-race cohorts.

To address this literature gap, the researchers assembled a cohort of 3,925 racially diverse men who were not treated within one year of diagnosis from 1997 to 2007. The population consisted of 749 Hispanic, 2,415 non-Hispanic white, 559 non-Hispanic Black, and 202 non-Hispanic Asian/Pacific Islander (API) men. Researchers used the Cox model of all-cause mortality as well as Fine-Gray sub distribution modeling to assess competing risk factors for poor outcomes.

According to the results, African Americans had higher rates of treatment juxtaposed to non-Hispanic whites (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.15-1.68). Black males also had an augmented risk of metastasis beyond 10 years after diagnosis (HR, 4.70; 95% CI, 2.30-9.61). Moreover, API and Hispanic males had lower rates of all-cause mortality (HR, 0.66; 95% CI, 0.52-0.84, and HR, 0.72; 95% CI, 0.62-0.85, respectively), while API men were observed as having lower rates of Pca mortality in the first 10 years after diagnosis (HR, 0.29; 95% CI, 0.09-0.90), but a higher risk beyond 10 years (HR, 5.41; 95% CI, 1.39-21.11).

“These data highlight the fact that there remains significant risk of metastasis and mortality beyond 10 years in men with untreated localized PCa, but this risk is not consistent across race/ethnicity groups,” the researchers concluded. “Despite observed differences in outcomes, most men in all studied racial/ethnic groups had favorable outcomes, which suggests that race should not be a disqualifying factor in choosing active surveillance among men with low‐risk PCa. Knowledge of these risks and their differences should help clinicians in their discussions with patients to better weigh risks and benefits of expectant management versus immediate treatment.”