title: Racial disparities in oncologic outcomes after radical prostatectomy: long-term follow-up.
abstract: OBJECTIVE
  To report race-based outcomes after radical prostatectomy (RP) in a cohort stratified by National Comprehensive Cancer Network (NCCN) risk category with updated follow-up.
  
  
  METHODS
  Studies describing racial disparities in outcomes after RP are conflicting. We studied 15,993 white and 1634 African American (AA) pretreatment-naïve men who underwent RP at our institution (1992-2013) with complete preoperative and pathologic data. Pathologic outcomes were compared between races using appropriate statistical tests; biochemical recurrence (BCR) for men with complete follow-up was compared using multivariate models that controlled separately for preoperative and postoperative covariates.
  
  
  RESULTS
  Very low- and low-risk AA men were more likely to have positive surgical margins (P <.01), adverse pathologic features (P <.01), and be upgraded at RP (P <.01). With a median follow-up of 4.0 years after RP, AA race was an independent predictor of BCR among NCCN low-risk (HR, 2.16; P <.001) and intermediate-risk (hazard ratio [HR], 1.34; P = .024) classes and pathologic Gleason score ≤ 6 (HR, 2.42; P <.001) and Gleason score 7 (HR, 1.71; P <.001). BCR-free survival for very low-risk AA men was similar to low-risk white men (P = .890); BCR-free survival for low-risk AA men was similar to intermediate-risk white men (P = .060).
  
  
  CONCLUSIONS
  When stratified by NCCN risk, AA men with very low-, low-, or intermediate-risk prostate cancer who undergo RP are more likely to have adverse pathologic findings and BCR compared with white men. AA men with "low risk" prostate cancer, especially those considering active surveillance, should be counseled that their recurrence risks can resemble those of whites in higher risk categories.
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD. Electronic address: ffaisal1@jhmi.edu.
authors.forename: Farzana A
authors.initials: FA
authors.lastname: Faisal
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Debasish
authors.initials: D
authors.lastname: Sundi
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: John L
authors.initials: JL
authors.lastname: Cooper
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Humphreys
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Misop
authors.initials: M
authors.lastname: Han
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Ross
authors.affiliation: Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schaeffer
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*