Racial Disparities in Prostate Cancere-Specific Mortality in Men With Low-Risk Prostate Cancer

This study examined the association of race and prostate cancere-specific mortality (PCSM) in 51,315 men with low-risk prostate cancer, using the Surveillance, Epidemiology, and End Results (SEER) database. African American men were found to have a higher risk of PCSM compared with white men, suggesting that further studies are needed to determine whether guidelines for active surveillance should take race into account. Background: Men with low-risk prostate cancer (CaP) are considered unlikely to die of CaP and have the option of active surveillance. This study evaluated whether African American (AA) men who present with low-risk disease are at higher risk for death from CaP than white men. Patients and Methods: The authors identified 56,045 men with low-risk CaP (T1-T2a, Gleason score <= 6, prostate-specific antigen <= 10 ng/mL) diagnosed between 2004 and 2009 using the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing-risks regression analyses were used to analyze the effect of race on prostate cancere-specific mortality (PCSM) after adjusting for known prognostic and sociodemographic factors in 51,315 men (43,792 white; 7523 AA) with clinical follow-up information available. Results: After a median follow-up of 46 months, 258 patients (209 [0.48%] white and 49 [0.65%] AA men) died from CaP. Both AA race (adjusted hazard ratio [AHR], 1.45; 95% CI, 1.03-2.05; P = .032) and noncurative management (AHR, 1.49; 95% CI, 1.15-1.95; P = .003) were significantly associated with an increased risk of PCSM. When analyzing only patients who underwent curative treatment, AA race (AHR, 1.62; 95% CI, 1.04-2.53; P = .034) remained significantly associated with increased PCSM. Conclusion: Among men with low-risk prostate cancer, AA race compared with white race was associated with a higher risk of PCSM, raising the possibility that clinicians may need to exercise caution when recommending active surveillance for AA men with low-risk disease. Further studies are needed to ultimately determine whether guidelines for active surveillance should take race into account. (C) 2014 Elsevier Inc. All rights reserved.