title: Active Surveillance for Favorable Risk Prostate Cancer in African Caribbean Men: Results of a Prospective Study.
abstract: Active surveillance is a treatment option for favorable risk prostate cancer. However, data are missing on populations of African descent. We evaluated the safety and benefit of active surveillance in an African Caribbean cohort with favorable risk prostate cancer.
  
  
  
  Between 2005 and 2016, a single center, prospective cohort study was performed in Guadeloupe, French West Indies, including patients on active surveillance who had low risk prostate cancer (prostate specific antigen 10 ng/ml or less and Gleason score 6 or less) or favorable intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, Gleason score 3 + 4 or less and life expectancy less than 10 years). Treatment was recommended in case of grade progression, increased tumor volume, prostate cancer doubling time less than 36 months or patient wish. Overall survival, disease specific survival and duration of active surveillance were calculated with the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards model to identify predictors of active surveillance termination.
  
  
  
  A total of 234 patients with a median age of 64 years were enrolled in study. Median followup was 4 years (IQR 2.3-5.5). Overall survival at 30 months, 5 years and 10 years was 99.5%, 98.5% and 90.7%, respectively. Disease specific survival at 30 months, and 5 and 10 years was 100%. At 30 months, 5 years and 10 years 72.7%, 52.6% and 40.4% of patients, respectively, remained untreated and on active surveillance. Age (HR 0.96 per additional year, 95% CI 0.93-0.99) and prostate specific antigen density (HR 1.52 per additional 0.1 ng/ml, 95% CI 1.20-1.89) were found to be independent predictors of active surveillance termination.
  
  
  
  Active surveillance is safe and beneficial for highly selected African Caribbean patients. It seems to be feasible for patients at low risk and intermediate favorable risk. Prostate specific antigen density could help better select these patients.
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France. Electronic address: matthias.meunier@yahoo.fr.
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Meunier
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Eyraud
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Sénéchal
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Gourtaud
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Roux
authors.affiliation: Department of Urology, Grenoble University Hospital, Grenoble, France.
authors.forename: Cécilia
authors.initials: C
authors.lastname: Lanchon
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France; Institut national de la santé et de la recherche médicale, U1085-IRSET and Université des Antilles, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brureau
authors.affiliation: Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe, France; Institut national de la santé et de la recherche médicale, U1085-IRSET and Université des Antilles, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Blanchet
mesh_terms: D000368:Aged; D044383:Black People; D017691:Caribbean Region; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: African continental ancestry group; Caribbean region; prostate-specific antigen; prostatic neoplasms; watchful waiting