Reclassification rates are higher among African American men than Caucasians on active surveillance

Debasish Sundi, Farzana A. Faisal, Bruce J. Trock, Patricia K. Landis, Zhaoyong Feng, Ashley E. Ross, H. Ballentine Carter, Edward M. Schaeffer*

*Corresponding author for this work

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Objective To evaluate the risk of reclassification on serial biopsy for Caucasian and African American (AA) men with very low-risk (VLR) prostate cancer enrolled in a large prospective active surveillance (AS) registry.

Methods The Johns Hopkins AS registry is a prospective observational study that has enrolled 982 men since 1994. Including only men who met all National Comprehensive Cancer Network VLR criteria (clinical stage ≤T1, Gleason score ≤6, prostate-specific antigen [PSA] level <10 ng/mL, PSA density <0.15 ng/mL/cm3, positive cores <3, percent cancer per core ≤50), we analyzed a cohort of 654 men (615 Caucasians and 39 AAs). The association of race with reclassification on serial biopsy was assessed with competing-risks regressions.

Results AA men on AS were more likely than Caucasians to experience upgrading on serial biopsy (36% vs 16%; adjusted P <.001). Adjusting for PSA level, prostate size, volume of cancer on biopsy, treatment year, and body mass index, AA race was an independent predictor of biopsy reclassification (subdistribution hazard ratio, 1.8; P =.003). Examining specific modes of reclassification, AA race was independently associated with reclassification by grade (subdistribution hazard ratio, 3.0; P =.002) but not by volume.

Conclusion AA men with VLR prostate cancer followed on AS are at significantly higher risk of grade reclassification compared with Caucasians. Therefore, if the goal of AS is to selectively monitor men with low-grade disease, AA men may require alternate selection criteria.

Original languageEnglish (US)
Pages (from-to)155-160
Number of pages6
JournalUrology
Volume85
Issue number1
DOIs
StatePublished - Jan 1 2015

ASJC Scopus subject areas

  • Urology

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    Sundi, D., Faisal, F. A., Trock, B. J., Landis, P. K., Feng, Z., Ross, A. E., Carter, H. B., & Schaeffer, E. M. (2015). Reclassification rates are higher among African American men than Caucasians on active surveillance. Urology, 85(1), 155-160. https://doi.org/10.1016/j.urology.2014.08.014