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.
Department of Urology, Wayne State University School of Medicine and Prostate Program of Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
Fernando J
FJ
Bianco
David P
DP
Wood
David J
DJ
Grignon
Wael A
WA
Sakr
J Edson
JE
Pontes
Isaac J
IJ
Powell
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