title: African American men with low-grade prostate cancer have increased disease recurrence after prostatectomy compared with Caucasian men.
abstract: OBJECTIVE
  To explore whether disparities in outcomes exist between African American (AA) and Caucasian (CS) men with low-grade prostate cancer and similar cancer of the prostate risk assessment-postsurgery (CAPRA-S) features following prostatectomy (RP).
  
  
  METHODS
  The overall cohort consisted of 1,265 men (234 AA and 1,031 CS) who met the National comprehensive cancer network criteria for low- to intermediate-risk prostate cancer and underwent RP between 1990 and 2012. We first evaluated whether clinical factors were associated with adverse pathologic outcomes and freedom from biochemical failure (FFbF) using the entire cohort. Next, we studied a subset of 705 men (112 AA and 593 CS) who had pathologic Gleason score≤6 (low-grade disease). Using this cohort, we determined whether race affected FFbF in men with RP-proven low-grade disease and similar CAPRA-S scores.
  
  
  RESULTS
  With a median follow-up time of 27 months, the overall 7-year FFbF rate was 86% vs. 79% in CS and AA men, respectively (P = 0.035). There was no significant difference in one or more adverse pathologic features between CS vs. AA men (27% vs. 31%; P = 0.35) or CAPRA-S score (P = 0.28). In the subset analysis of patients with low-grade disease, AA race was associated with worse FFbF outcomes (P = 0.002). Furthermore, AA race was a significant predictor of FFbF in men with low-grade disease (hazard ratio = 2.01, 95% CI: 1.08-3.72; P = 0.029).
  
  
  CONCLUSIONS
  AA race is a predictor of worse FFbF outcomes in men with low-grade disease after RP. These results suggest that a subset of AA men with low-grade disease may benefit from more aggressive treatment.
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA. Electronic address: Kosj.Yamoah@Jeffersonhospital.org.
authors.forename: Kosj
authors.initials: K
authors.lastname: Yamoah
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Curtiland
authors.initials: C
authors.lastname: Deville
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Spangler
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Charnita M
authors.initials: CM
authors.lastname: Zeigler-Johnson
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Malkowicz
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Michael
authors.initials: M
authors.lastname: Kattan
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Rebbeck
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
keywords: Adverse pathologic features; African American race; Biochemical failure; Disparities