title: Active surveillance for low-risk prostate cancer in African American men: a multi-institutional experience.
abstract: OBJECTIVE
  To compare the outcomes of active surveillance (AS) series between African American men (AAM) and non-AAM diagnosed with low-risk prostate cancer at 3 medical centers.
  
  
  METHODS
  Between 2005 and 2012, 214 men accepted AS on the basis of favorable clinical features and parameters after initial and repeat biopsy. Failure was defined as increase in Gleason score >6, total positive cores >33%, maximum cancer volume in any core >50%, or a prostate-specific antigen >10 ng/mL. Disease progression and overall AS failure were compared between the 2 groups.
  
  
  RESULTS
  Of 214 men, 75 were excluded, leaving 67 AAM and 72 non-AAM on AS. Median age at diagnosis was 64 and 67 years for AAM and non-AAM, respectively, and median follow-up was 34 and 46 months, respectively. During this time, 44 AAM (66%) remained on AS, and 23 (34%) underwent treatment, of whom 6 (26%) were treated by patient choice and 17 (74%) because of disease progression. In the non-AAM group, 59 (82%) men remained on AS, and 13 (18%) underwent treatment, 8 (62%) were treated by patient choice and 5 (38%) because of disease progression. The 3-year freedom from overall treatment was 74% and did not differ by race (P = .06). The 3-year freedom from disease progression was 85%, where AAM were at significantly higher risk of disease progression (hazard ratio = 3.8; 95% confidence interval: 1.4-10.4; P = .01).
  
  
  CONCLUSIONS
  Our study suggests a higher disease progression rate in AAM who choose AS for low-risk prostate cancer compared with non-AAM, signifying a potential need for closer follow-up and more stringent enrollment criteria in AAM.
authors.affiliation: Detroit Medical Center, Michigan State University College of Osteopathic Medicine, Detroit, MI.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Odom
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: M C
authors.initials: MC
authors.lastname: Mir
authors.affiliation: Detroit Medical Center, Michigan State University College of Osteopathic Medicine, Detroit, MI.
authors.forename: Scott
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Centre Hospitalier Universitaire, Pointe-á-Pitre, Guadeloupe, France.
authors.forename: Cedric
authors.initials: C
authors.lastname: Senechal
authors.affiliation: Centre Hospitalier Universitaire, Pointe-á-Pitre, Guadeloupe, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Santy
authors.affiliation: Centre Hospitalier Universitaire, Pointe-á-Pitre, Guadeloupe, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Eyraud
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.affiliation: Department of Epidemiology and Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ylitalo
authors.affiliation: Detroit Medical Center, Michigan State University College of Osteopathic Medicine, Detroit, MI. Electronic address: rmiocinovic@gmail.com.
authors.forename: Ranko
authors.initials: R
authors.lastname: Miocinovic
mesh_terms: D001741:Black or African American; D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D057832:Watchful Waiting