Prostate cancer stage shift has eliminated the gap in disease-free survival in black and white American men after radical prostatectomy.
OBJECTIVE
The initiation of prostate specific antigen (PSA) testing has led to increased public awareness, early detection and a stage shift in prostate cancer. We have previously reported that black American men have worse disease-free survival independently of pathological or clinical factors. We tested the stage shift effects on disease-free survival in our cohort of patients treated with radical prostatectomy.


METHODS
A total of 1,042 consecutive patients underwent radical prostatectomy performed by Wayne State University full-time faculty. The cohort was divided by the year of surgery as before (585 men in group 1) or after (457 in group 2) 1996. Clinicopathological and disease-free survival data were obtained from the Karmanos Cancer Institute multidisciplinary prostate cancer database.


RESULTS
Improvements in clinical stage, preoperative PSA and biopsy Gleason score were observed in group 2 (p = 0.0001). Pathological organ confined disease increased in group 2 versus 1 in the 2 races, including 89 of 153 (58%) from 66 of 178 (37%) in black men and 189 of 304 (62%) from 194 of 407 (48%) in white men (p = 0.003 and 0.001, respectively). Calculated cancer recurrence-free median probability in group 1 at 42 months was 81% and 68% in white and black men, respectively (log rank test p = 0.001). These differences became insignificant in group 2 patients at 42 months with a median probability of 90% and 88% in white and black men, respectively (log rank test p = 0.39), representing a net increase in disease-free survival of 20% in black men. Specimen Gleason score, PSA and pathological stage were independent predictors of survival in the 2 groups. In contrast, race was an independent predictor only in group 1.


CONCLUSIONS
The increased rate of pathological organ confined disease is translating into improved disease-free survival rates. These early data suggest that the survival gap in black and white American men is narrowing and may become statistically insignificant.
Bianco
Fernando J
FJ
Department of Urology, Wayne State University School of Medicine and Prostate Program of Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
Wood
David P
DP
Grignon
David J
DJ
Sakr
Wael A
WA
Pontes
J Edson
JE
Powell
Isaac J
IJ
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D044383:Black People; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D044465:White People; D001741:Black or African American
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen