title: Racial variation in prostate cancer upgrading and upstaging among men with low-risk clinical characteristics.
abstract: BACKGROUND
  African American (AA) men suffer a higher prostate cancer (PCa) burden than other groups.
  
  
  OBJECTIVE
  We aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance.
  
  
  METHODS
  We studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site.
  
  
  CONCLUSIONS
  Of 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n=273; 6.5%), Caucasian (n=3771; 89.1%), or other racial/ethnic group (Other; n=187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: ±7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups (p<0.01). We found an association between race group and PSM rate (p<0.03), with higher odds of PSMs in AA men versus Caucasian men (odds ratio [OR]: 1.64; 95% confidence interval [CI], 1.08-2.47). No statistically significant associations between race and rates of upgrading and upstaging were found. This study was limited by the relatively low proportion of AA men in the cohort.
  
  
  CONCLUSIONS
  Among clinically low-risk men who underwent RP, AA men had a higher likelihood of PSMs compared with Caucasian men. We did not find statistically significantly different rates of upgrading and upstaging between the race groups.
  
  
  RESULTS
  We analyzed two large groups of men with what appeared to be low-risk prostate cancer based on the initial biopsy findings. The likelihood of finding worse disease (higher grade or stage) at the time of surgery was similar across different racial groups.
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jalloh
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Myers
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA. Electronic address: mcooperberg@urology.ucsf.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D001741:Black or African American; D000368:Aged; D001706:Biopsy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: African American; Grade; Prostate cancer; Racial disparities; Radical prostatectomy; Risk assessment; Stage