title: African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them?
abstract: OBJECTIVE
  Active surveillance (AS) is a treatment option for men with very low-risk prostate cancer (PCa); however, favorable outcomes achieved for men in AS are based on cohorts that under-represent African American (AA) men. To explore whether race-based health disparities exist among men with very low-risk PCa, we evaluated oncologic outcomes of AA men with very low-risk PCa who were candidates for AS but elected to undergo radical prostatectomy (RP).
  
  
  METHODS
  We studied 1,801 men (256 AA, 1,473 white men, and 72 others) who met National Comprehensive Cancer Network criteria for very low-risk PCa and underwent RP. Presenting characteristics, pathologic data, and cancer recurrence were compared among the groups. Multivariable modeling was performed to assess the association of race with upgrading and adverse pathologic features.
  
  
  RESULTS
  AA men with very low-risk PCa had more adverse pathologic features at RP and poorer oncologic outcomes. AA men were more likely to experience disease upgrading at prostatectomy (27.3% v 14.4%; P < .001), positive surgical margins (9.8% v 5.9%; P = .02), and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system (CAPRA-S) scores. On multivariable analysis, AA race was an independent predictor of adverse pathologic features (odds ratio, [OR], 3.23; P = .03) and pathologic upgrading (OR, 2.26; P = .03).
  
  
  CONCLUSIONS
  AA men with very low-risk PCa who meet criteria for AS but undergo immediate surgery experience significantly higher rates of upgrading and adverse pathology than do white men and men of other races. AA men with very low-risk PCa should be counseled about increased oncologic risk when deciding among their disease management options.
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Debasish
authors.initials: D
authors.lastname: Sundi
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Ross
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Humphreys
authors.forename: Misop
authors.initials: M
authors.lastname: Han
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schaeffer
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data