title: Risk of Pathological Upgrading and Up Staging among Men with Low Risk Prostate Cancer Varies by Race: Results from the National Cancer Database.
abstract: The impact of African-American race on oncologic outcomes for low risk prostate cancer is unclear due to conflicting data. We investigated the effect of African-American race on pathological upgrading and/or up staging at prostatectomy in men with clinically low risk prostate cancer.
  
  
  
  We queried the National Cancer Database for men with low risk prostate cancer (clinical stage T2a or less, Gleason score 6 or less, prostate specific antigen less than 10 ng/ml) treated with radical prostatectomy between 2010 and 2013. The outcomes were pathological upgrading to Gleason score greater than 6 (primary) or Gleason score greater than 3+4=7 (secondary) and/or up staging (pathological T3-4 or N1 disease). The association between race and the end points was assessed using multivariable logistic regression. To further adjust for potential confounders, stratification by urban residence and comorbidity score, and subgroup analyses were performed.
  
  
  
  With adjustment for age, comorbidity, income, urban residence, T stage, prostate specific antigen and percentage of positive biopsy cores, African-American race conferred 1.2-fold higher odds of pathological upgrading to Gleason score greater than 6 and/or up staging (OR 1.2, 95% CI 1.1-1.3, p <0.01). African-American race also was an independent predictor of pathological upgrading to Gleason score greater than 3+4=7 and/or up staging (p=0.03).
  
  
  
  African-American men with low risk prostate cancer are more likely to harbor higher risk disease, which may lead to adverse outcomes. This finding alone does not preclude active surveillance. However, race should be considered as men weigh the risks and benefits of active surveillance vs treatment.
authors: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Matthew J
authors: MJ
authors: Maurice
authors: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Debasish
authors: D
authors: Sundi
authors: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Edward M
authors: EM
authors: Schaeffer
authors: Department of Urology, University Hospitals Case Medical Center, Cleveland, Ohio. Electronic address: robert.abouassaly@uhhospitals.org.
authors: Robert
authors: R
authors: Abouassaly
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D001706:Biopsy; D003710:Demography; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D012306:Risk
chemical_list: D017430:Prostate-Specific Antigen
keywords: African Continental Ancestry Group; neoplasm grading; neoplasm staging; prostatic neoplasms; watchful waiting