Examine reveals lively surveillance to be secure for African American males with low-risk prostate most cancers

Previous studies have shown that African American men are 2.4 times more likely to die from prostate cancer than non-Hispanic white men. This, combined with concerns that African Americans might develop more aggressive cancers, has resulted in fewer black men being offered active surveillance as a treatment strategy.

Prostate cancer usually grows slowly. A low-risk disease may not need immediate treatment, if at all. Instead, a doctor may recommend active monitoring – closely monitoring the progression of the disease with prostate specific antigen (PSA) blood tests, digital rectal prostate exams, and biopsies – to avoid over-treatment and associated side effects from surgery, chemotherapy, and other treatments .

Our research provides evidence that active surveillance is safe for African American men. This means more African American men can avoid definitive treatment and the associated side effects of urinary incontinence, erectile dysfunction, and bowel problems. “

Brent Rose, MD, Assistant Professor, Department of Radiation Medicine and Applied Sciences, University of California Medical School, San Diego

In a study published in the November 3, 2020 online edition of JAMA, Rose and colleagues tested the hypothesis that African American men who undergo active surveillance are at significantly higher risk of disease progression, metastasis (spread), and Death from prostate cancer than did non-Hispanic white men.

They found that 59.9 percent of African American men experienced disease progression, compared with 48.3 percent of white men. In addition, 54.8 of African Americans required treatment, compared with 41.4 percent of white men. According to the study’s authors, both are statistically significant increases.

However, African American men and white men have comparable rates of metastasis (1.5 percent versus 1.4 percent) and prostate cancer-specific deaths (1.1 percent versus 1.0 percent).

After skin cancer, prostate cancer is the most common type of cancer in men. Every ninth man will be diagnosed with prostate cancer at some point in his life. Prostate cancer is more likely to occur in older men and in African American men. While the average age for diagnosis is 66 years, the number of younger men diagnosed with the disease is increasing.

Active surveillance is the preferred treatment option for many low-risk men with low-risk prostate cancer to avoid or delay the side effects of definitive treatments. African American men should not be excluded from active surveillance protocols.

Instead, write to the authors that changes and improvements in patient selection and close follow-up are needed to achieve beneficial outcomes for all patients.

“Physicians and patients should discuss active monitoring of low-risk African American men with prostate cancer,” said Rose, radiation oncologist at UC San Diego Health’s Moores Cancer Center and senior author of the paper. “The overall results are similar in African American men and white men. However, because of the increased risk of progression, African American men must be carefully monitored and treated promptly if their cancer progresses.”

The retrospective study examined and found 2,280 African American men and 6,446 non-Hispanic white men with low-risk prostate cancer who were actively monitored as part of VA health care. The database included access to the health records of 9 million veterans between 2000 and 2020 who were cared for in 1,255 health facilities in the United States.

Source:

University of California – San Diego

Journal reference:

Deka, R. et al. (2020) Association between African American Race and Clinical Outcomes in Men Treated with Active Surveillance for Low Risk Prostate Cancer. JAMA. doi.org/10.1001/jama.2020.17020.

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