Does race affect prostate cancer outcomes after a radical prostatectomy?

The authors aimed to determine whether African Americans were more at risk of experiencing recurrent prostate cancer or complications following a radical prostatectomy. 

Past research has shown that African American men are 60% more likely to experience prostate cancer than white men. Previously, in men who received a prostatectomy (surgical removal of the prostate gland), African Americans had higher Gleason scores (scoring system that compares the differences between normal and cancer cells), higher PSA levels (protein found in the blood that is elevated when prostate cancer is present) and higher tumor volumes (size of the tumor) following treatment when compared to white men. However, there has been conflicting conclusions from published research on whether race has an effect on cancer recurrence and complications following treatment.

The following article aimed to determine whether race influences treatment outcomes following a radical prostatectomy.

17, 627 men were used in this study where 1,634 were African American with an average follow-up of 4 years. Patients were grouped into the following categories: very low risk, low risk, intermediate risk and high risk.

After the operation, African Americans were more likely to have higher Gleason scores and to have positive surgical margins (cancer cells come right out to the edge of the removed tissue and usually means more surgery is needed), particularly in very low risk (10.5% compared to 5.8% in white men), low risk (14% compared to 10.5% in white men) and intermediate risk (19.7% compared to 16.1% in white men) patients. African American men also had lower biochemical recurrence-free survival rates (68.2%) (percentage of men surviving without rising PSA levels) than white men (81.4%).

However, 10 year metastasis-free survival (time from diagnosis until the cancer spreads) and prostate cancer-specific survival (time from diagnosis to prostate cancer death) rates were very similar between African American and white patients.

When advanced analysis was used to determine risk of biochemical recurrence (rising PSA levels following treatment) African American race was identified as an independent predictor of biochemical recurrence.  African American patients with a Gleason score of less than 6 were 2.4 times more likely to experience biochemical recurrence compared to white patients. African American patients with T2N0 (cancer that is confined to the prostate) were 2.87 times more likely and T3N0 (spread from the prostate but not into the lymph nodes) were 2.3 times more likely to experience cancer recurrence than white patients.

African American patients with a Gleason score of 7 were almost twice as likely to experience cancer recurrence in cases of cancer confined to the prostate and cancer that had spread from the prostate. African American T2N0 patients with a Gleason score of 8 were four times more likely to experience cancer recurrence.

The authors concluded that African American men who undergo radical prostatectomy are more likely to experience cancer recurrence and complications after treatment than white men.

This study did not include information on additional factors that may effect racial differences so results can not be widely applied in all situations. 

Please consult your doctor if you are considering a radical prostatectomy and are concerned with your risk of experiencing complications after treatment.