Is active surveillance an option for African American men with low-risk prostate cancer?

This study examined the possible role of active surveillance (AS) as a treatment strategy for African American (AA) men whose prostate cancer is considered to be of low-risk.

Prostate cancer is a condition in which cells of the prostate gland grow and divide uncontrollably. In some cases, this uncontrolled growth proceeds very slowly and may take years to develop into a life threatening condition. These cancers are termed low-risk. In these cases close observation rather than immediate treatment is often recommended. This treatment strategy is known as active surveillance. When treatment of the cancer is necessary, a radical prostatectomy (surgical removal of the prostate) is preformed. However, recent studies showing the benefits of AS have under-represented AA men. In addition, AA men undergoing radical prostatectomy have been shown to experience worse outcomes compared to white patients. To determine the possible role of AS in AA men, this study examined the aggressiveness of the disease in men who were candidates for AS, but elected to undergo a radical prostatectomy instead.

This study included 1801 men with prostate cancer, all of whom opted to receive a radical prostatectomy despite having very low-risk prostate cancer. Patients were followed for an average of 3 years.

When examining the tumor after removal, AA men were found to be more likely to have a more aggressive tumor than initially expected before surgery. Surgery on AA men was also almost twice as likely to fail to remove all parts of the tumor compared to surgery on white men. 4% of AA men suffered recurrence of the cancer after surgery compared to only 1.4% of white patients.

This study concluded that prostate cancer in African American patients tends to be more aggressive than in white patients, resulting in significantly worse outcomes after a radical prostatectomy. This should be taken into consideration when deciding on a treatment strategy. Although active surveillance might be a viable treatment strategy, adjustments in the surveillance protocols may be necessary to address this increased risk in AA patients.

While this study addressed the differences in surgical outcomes among AA men, a study directly measuring the benefit of active surveillance in this population is needed to reach more conclusive recommendations.

Consult with your physician regarding the benefits and risks of active surveillance in the management of low risk prostate cancer.