title: African-american race is a predictor of seminal vesicle invasion after radical prostatectomy.
abstract: BACKGROUND
  The purpose of the study was to determine whether racial differences exist in the pattern of local disease progression among men treated with radical prostatectomy (RP) for localized prostate cancer (PCa), which is currently unknown. In this study we evaluated the pattern of adverse pathologic features in an identical cohort of African-American (AA) and Caucasian (CS) men with PCa.
  
  
  METHODS
  The overall cohort consisted of 1104 men (224 AA, and 880 CS) who underwent RP between 1990 and 2012. We compared preoperative factors and pathologic outcomes after RP across race groups. Multivariate analysis was used to identify factors predictive of adverse pathologic outcomes. The effect of race on adverse pathologic outcomes and biochemical control rate (BCR) was evaluated using multivariate regression model and Kaplan-Meier analysis.
  
  
  RESULTS
  The 10-year BCR was 59% versus 82% in AA and CS men, respectively (P = .003). There was no significant difference in extraprostatic spread (P = .14), positive surgical margin (P = .81), lymph node involvement (P = .71), or adverse pathologic features (P = .16) across race groups. However, among patients with ≥ 1 adverse pathologic features, AA men had higher rate of seminal vesicle invasion (SVI) compared with CS men (51% vs. 30%; P = .01). After adjusting for known predictors of adverse pathologic features AA race remained a predictor of SVI.
  
  
  CONCLUSIONS
  AA men have an increased risk of SVI after RP, particularly among men with Gleason ≤ 6 disease. This might represent racial differences in the biology of PCa disease progression, which contribute to poorer outcomes in AA men.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: jkosjc@gmail.com.
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: Amy
authors.initials: A
authors.lastname: Walker
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, Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University Hospital, 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: Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University Hospital, 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
authors.affiliation: The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Priti
authors.initials: P
authors.lastname: Lal
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D012669:Seminal Vesicles / Q000473:pathology*; D014481:United States / Q000208:ethnology; D044465:White People
keywords: Adverse pathologic features invasion; African-American; Biochemical failure; Black men; Disparities; Prostate cancer; Seminal vesicle invasion