Multi-institution analysis of racial disparity among African- American men eligible for prostate cancer active surveillance

Michael Dinizo, Weichung Shih, Young Suk Kwon, Daniel Eun, Adam Reese, Laura Giusto, Edouard J. Trabulsi, Bertram Yuh, Nora Ruel, Daniel Marchalik, Jonathan Hwang, Shilajit D Kundu, Scott Eggener, Isaac Yi Kim

Research output: Contribution to journalArticle

Abstract

There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African- American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003-2014 were used to assess potential racial disparity. Of the 333 (14.8%) African-American and 1923 (85.2%) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p < 0.01), preop PSA (5.2 v 4.7; p < 0.01), and maximum percentage cancer on biopsy (15.1% v 13.6%; p < 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed.

Original languageEnglish (US)
Pages (from-to)21359-21365
Number of pages7
JournalOncotarget
Volume9
Issue number30
DOIs
StatePublished - Apr 20 2018

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African Americans
Prostatic Neoplasms
Prostatectomy
Tertiary Healthcare
Neoplasms
Multivariate Analysis
Databases
Prospective Studies
Biopsy
Recurrence

Keywords

  • Active surveillance
  • Prostate cancer
  • Racial disparity

ASJC Scopus subject areas

  • Oncology

Cite this

Dinizo, Michael ; Shih, Weichung ; Kwon, Young Suk ; Eun, Daniel ; Reese, Adam ; Giusto, Laura ; Trabulsi, Edouard J. ; Yuh, Bertram ; Ruel, Nora ; Marchalik, Daniel ; Hwang, Jonathan ; Kundu, Shilajit D ; Eggener, Scott ; Kim, Isaac Yi. / Multi-institution analysis of racial disparity among African- American men eligible for prostate cancer active surveillance. In: Oncotarget. 2018 ; Vol. 9, No. 30. pp. 21359-21365.
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abstract = "There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African- American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003-2014 were used to assess potential racial disparity. Of the 333 (14.8{\%}) African-American and 1923 (85.2{\%}) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p < 0.01), preop PSA (5.2 v 4.7; p < 0.01), and maximum percentage cancer on biopsy (15.1{\%} v 13.6{\%}; p < 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed.",
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Dinizo, M, Shih, W, Kwon, YS, Eun, D, Reese, A, Giusto, L, Trabulsi, EJ, Yuh, B, Ruel, N, Marchalik, D, Hwang, J, Kundu, SD, Eggener, S & Kim, IY 2018, 'Multi-institution analysis of racial disparity among African- American men eligible for prostate cancer active surveillance' Oncotarget, vol. 9, no. 30, pp. 21359-21365. https://doi.org/10.18632/oncotarget.25103

Multi-institution analysis of racial disparity among African- American men eligible for prostate cancer active surveillance. / Dinizo, Michael; Shih, Weichung; Kwon, Young Suk; Eun, Daniel; Reese, Adam; Giusto, Laura; Trabulsi, Edouard J.; Yuh, Bertram; Ruel, Nora; Marchalik, Daniel; Hwang, Jonathan; Kundu, Shilajit D; Eggener, Scott; Kim, Isaac Yi.

In: Oncotarget, Vol. 9, No. 30, 20.04.2018, p. 21359-21365.

Research output: Contribution to journalArticle

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T1 - Multi-institution analysis of racial disparity among African- American men eligible for prostate cancer active surveillance

AU - Dinizo, Michael

AU - Shih, Weichung

AU - Kwon, Young Suk

AU - Eun, Daniel

AU - Reese, Adam

AU - Giusto, Laura

AU - Trabulsi, Edouard J.

AU - Yuh, Bertram

AU - Ruel, Nora

AU - Marchalik, Daniel

AU - Hwang, Jonathan

AU - Kundu, Shilajit D

AU - Eggener, Scott

AU - Kim, Isaac Yi

PY - 2018/4/20

Y1 - 2018/4/20

N2 - There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African- American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003-2014 were used to assess potential racial disparity. Of the 333 (14.8%) African-American and 1923 (85.2%) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p < 0.01), preop PSA (5.2 v 4.7; p < 0.01), and maximum percentage cancer on biopsy (15.1% v 13.6%; p < 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed.

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