African Americans experience higher rates of reclassification during active surveillance

The authors aimed to determine whether African Americans underwent more frequent reclassifications than Caucasians on active surveillance.

Active surveillance involves close observation of the cancer to detect any signs of cancer progression rather than immediate treatment. This is typically carried out in patients who are classified as very-low risk (cancer is contained in the prostate and is only detected by elevated prostate specific antigen [PSA – protein that increases when  prostate cancer is present] levels in the blood).

Reclassification means that the cancer status has changed based on results evaluated through methods such as biopsy (tissue sample taken) which can be used to indicate patients Gleason score grade (scoring system used to compare the differences between normal cells and cancer cells), tumor volume (the amount of tumor present) and cancer stage.

The aim of this article was to determine whether African American patients underwent reclassification more frequently than Caucasians when on active surveillance.

This study included a total of 654 patients, 39 African Americans and 615 Caucasians. The average follow-up time was 32 months.

69% of African American patients experienced cancer progression during active surveillance based on increases in either Gleason grade or volume compared to 60% of Caucasians. 39% of African Americans experienced cancer progression as a result of grade and volume increases compared to 29% of Caucasians. 

Using advanced analysis African American race was determined as an independent risk factor in overall biopsy reclassification (biopsy results leading to reclassification) where the risk of cancer progression resulting in reclassification was 80% higher in African Americans than in Caucasians. African American patients were 3 times more at risk of experiencing grade reclassification upwards to Gleason grade greater than or equal to 7 compared to Caucasian patients during the study follow-up period. 

The authors concluded that African Americans are more at risk of reclassification during active surveillance than Caucasians.

The follow-up time for this experiment was relatively short so long-term predictions cannot be made. 

Please consult your doctor if you have concerns about active surveillance, and the level of surveillance required dependent on race risk factors.