Offering Black men active surveillance to manage low-risk prostate cancer is safe and does not increase the risk of disease spreading or death more than it does for white men, a study has found.
However, Black men on active surveillance are more likely to progress and require definitive treatment, researchers said, and further investigation is needed to assess the long-term survival outcomes in these patients.
The study, “Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance,” was published in the Journal of the American Medical Association.
“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,” Brent Rose, MD, the study’s senior author, said in a press release.
While prostate cancer is the most common cancer among men, a great number of cases will remain dormant and not progress to significant disability or risk of death, making immediate treatment unnecessary.
In such cases, doctors may recommend active surveillance, which involves carefully monitoring the disease for progression through regular prostate exams, tissue biopsies, and prostate-specific antigen blood tests. Because definitive treatments like surgery or chemotherapy carry significant risks and side effects, active surveillance often is the preferred treatment approach.
Black men in the U.S. are 2.4-times more likely than white men to die from prostate cancer, at least partially due to the increased occurrence of more aggressive prostate cancer in Black men. Due to this risk disparity, black men are far less likely to be recommended active surveillance as a treatment option.
To determine whether the option is safe for Black men, a research team at the University of California, San Diego and elsewhere evaluated clinical outcomes of active surveillance in Blacks and non-Hispanic white men with low-risk prostate cancer.
The study included data from 8,726 men from the U.S. Veterans Health Administration (VHA) healthcare system, diagnosed with low-risk prostate cancer from 2001 to 2015, and treated with active surveillance. Of the men included in the study, 2,280 were black with a median age of 63.2, and 6,446 were white with a median age of 65.5.
Over a median of 7.6 years, more Black men had experienced disease progression (59.9%) compared with white men (48.3%), and more had required definitive treatment (54.8% versus 41.4%).
After accounting for multiple confounding factors, statistical analysis confirmed that Black men were 30% more likely to experience disease progression and also 30% more likely to require definitive treatment after being offered active surveillance.
However, researchers found that Black men were not more likely than white men to experience metastatic disease or to die, either from prostate cancer or from other causes, indicating that the treatment option is safe for the population.
Over the course of 10 years, 1.5% of Black men acquired metastasis, 1.1 died from prostate cancer, and 21.2% died of causes other than prostate cancer. Similarly, 1.4% of white men had metastasis, 1% died of prostate cancer, and 22.4% died of other causes.
“The estimates of metastases and prostate cancer-specific mortality for African American men in this cohort are broadly in line with results from … studies composed of predominantly White men, suggesting that African American men should not be excluded from active surveillance protocols,” the investigators wrote.
The study may be limited by potential differences in active surveillance protocols, lack of information about metastasis evaluation, use of patient data solely within the VHA system, and potential for race-based disparities in treatment that may affect patient outcomes.