Tougher Criteria May be Needed for African Americans Considering Prostate Cancer Surveillance
New Brunswick, N.J. – New research from The Cancer Institute of New Jersey suggests that more stringent criteria may be needed for African American men with prostate cancer when considering active surveillance of the disease. The findings, published in the latest online version of Urology (doi: 10.1016/j.urology.2012.12.046) found that the prevalence of advanced stage cancer in African American men who were considered to have a low-risk prostate cancer on initial consultation but chose to undergo a radical prostatectomy was nearly twice that of Caucasian men. These findings of more advanced disease, confirmed through analysis of tissue specimens collected during surgery, suggest that the definition of low-risk prostate cancer should not be the same for African American and Caucasian men. The Cancer Institute of New Jersey is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.
Recent studies have shown that just monitoring prostate cancer without aggressive intervention can be a viable treatment option for men with low risk disease. However, because African American men tend to have more aggressive disease than Caucasian men, it is unclear whether the same criteria for active surveillance should be applied to African American patients. Investigators at The Cancer Institute of New Jersey further explored this issue.
A retrospective analysis was performed using data from men who underwent a radical prostatectomy by surgeons at The Cancer Institute of New Jersey and Johns Hopkins medical institutions between 1997 and 2011. Out of 1,536 African American men identified, 196 men met eligibility criteria for active surveillance based on University of California – San Francisco (UCSF) guidelines, which include a prostate specific antigen (PSA) score of 10 ng/mL or less and a clinical stage T1/T2a tumor. A smaller cohort of 124 African American men met the eligibility criteria under National Comprehensive Cancer Network (NCCN) guidelines, which include a life expectancy of less than ten years with a PSA of less than 10 ng/mL. For comparison, 608 Caucasian men were identified, with 191 and 143 men meeting eligibility criteria under UCSF and NCCN guidelines respectively.
Investigators found that the rate of higher grade disease in African American men believed at first to have very low risk prostate cancer based on the UCSF and NCCN guidelines was slightly higher (37.2 to 46.0 percent) but not significantly different from that of Caucasian men (33.5 to 39.2 percent). However, the risk of advanced stage disease was almost twice as high in blacks (19.4 percent) as in whites (10.1 percent). Advanced stage is defined as T3 or greater, which indicates growth outside of the prostate. In other words, among patients who are believed before surgery to have low risk disease, blacks are twice as likely as whites to have what is in fact advanced prostate cancer.
A multivariate analysis also revealed that age, preoperative PSA level and number of positive biopsy cores were independent predictors of more advanced disease in African Americans.
“Considering these higher incidences of more advanced prostate cancer in African American men, our findings suggest that more stringent criteria may be needed for those in this population who are considering active surveillance,” said senior author Isaac Yi Kim, MD, PhD, chief of the Section of Urologic Oncology at The Cancer Institute of New Jersey and associate professor of surgery at UMDNJ-Robert Wood Johnson Medical School. “We recommend a lower PSA cutoff and/or a single positive biopsy core be considered as inclusion criteria, although further study is needed,” noted Dr. Kim, who is also the executive director of the Dean and Betty Gallo Prostate Cancer Center at The Cancer Institute of New Jersey.
The authors note limitations within the study including the lack of assessment of PSA velocity and density. They also believe that additional biomarkers and further refinement of imaging modalities are needed to better stratify the risk of those prostate cancer patients who are considering active surveillance. Despite these limitations, they say “more conservative active surveillance criteria should be adopted for African American men until these tools are developed and validated.”
Along with Kim, the author team consists of Yun-Sok Ha, MD, PhD, Amirall Saimasi, MD, Michael Karellas, MD, Eric A. Singer, MD, and Jeong Hyun Kim, MD, PhD The Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School; Misop Han, MD, and Alan W. Partin, MD, PhD, Johns Hopkins University; Wun-Jae Kim, MD, PhD, Chungbuk National University; and Dong Hyeon Lee, MD, PhD, Ewah Woman’s University.
The study was supported in part by the Marion and Norman Tanzman Foundation, Jon Runyan’s Score for the Cure, the National Research Foundation of Korea (2012-0000476) and the Rural Development Administration, Republic of Korea (PJ0081952011).
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The Cancer Institute of New Jersey (www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center dedicated to improving the detection, treatment and care of patients with cancer, and serving as an education resource for cancer prevention. Physician-scientists at The Cancer Institute of New Jersey engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. To make a tax-deductible gift to support The Cancer Institute of New Jersey, call 732-235-8614 or visit www.cinjfoundation.org. Follow us on Facebook at www.facebook.com/TheCINJ.
The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community Hospital). Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Medical Center, Carol G. Simon Cancer Center at Overlook Medical Center, and Cooper University Hospital. Affiliate Hospitals: CentraState Healthcare System, JFK Medical Center, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), Somerset Medical Center, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center of Princeton at Plainsboro. *Academic Affiliate