title: A Population-Based Study of Men With Low-Volume Low-Risk Prostate Cancer: Does African-American Race Predict for More Aggressive Disease?
abstract: BACKGROUND
  Because of recent reports that suggested more pathologically aggressive disease in African-American (AA) men, we sought to compare pathologic features between AA and Caucasian-American men with low-risk, low-volume prostate cancer.
  
  
  METHODS
  We analyzed the Surveillance, Epidemiology, and End Results database for pathologic differences based on race. Data on all men who were diagnosed between 2010 and 2011 with prostate cancer, T1cN0M0, Gleason score of 6 (3+3), prostate-specific antigen < 10 ng/mL, via a 12-core biopsy and had ≤ 2 positive samples, and underwent radical prostatectomy were abstracted. Univariate and multivariate logistic regression were performed to detect predictors for adverse pathology, which was primarily defined as pT2 and Gleason ≥ 4+3, or pT3a and Gleason 3+3 with positive margins, pT3a and Gleason ≥ 3+4, or pT3b-pT4 with any Gleason score.
  
  
  RESULTS
  There were 1794 men who met the target study criteria. AA men were a median of 3 years younger (P < .001), and were more likely to have 2 positive cores (P = .02). However, there were no statistically significant differences between Caucasian and AA men regarding pathologic Gleason score (P = .99), pathologic extent of disease (P = .34), margins (P = .43), Cancer of the Prostate Risk Assessment score (P = .56), or adverse features (P = .45). On multivariate analysis, there were no differences between AA and Caucasian men with regard to adverse pathologic features (odds ratio, 1.43; 95% confidence interval, 0.87-1.24; P = .16).
  
  
  CONCLUSIONS
  In the absence of definitive data to support a more aggressive natural history of very low risk prostate cancer in AA men, these data support continued use of active surveillance in this population.
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY. Electronic address: David.schreiber@va.gov.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Arpit
authors.initials: A
authors.lastname: Chhabra
authors.affiliation: UF Orlando Health, Orlando, FL.
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.affiliation: SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Weedon
authors.affiliation: Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D062486:Public Health Surveillance; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data
keywords: Active surveillance; Prostate cancer; Racial disparities; Radical prostatectomy