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Active surveillance appears to be safe option for Black men with low-risk prostate cancer

Reuters Health - 03/11/2020 - Active surveillance appears to be an equally safe option for African-American men with low-risk prostate cancer, according to a retrospective analysis.

While Black men were more likely than their non-Hispanic white peers to have disease progression and need definitive treatment over 10 years, they did not have an increased risk of their cancer spreading or of dying of prostate cancer, researchers report in JAMA.

Active surveillance is recommended for patients with low-risk prostate cancer. But there has been lower uptake of active surveillance in Black men with low-risk prostate cancer.

"People used to think active surveillance was not safe in African-American men because of a perception that the cancer was inherently more aggressive. This led to unnecessary treatments and side effects like urinary incontinence, erectile dysfunction and bowel problems for African-American men," said Dr. Brent Rose, assistant professor of radiation oncology at the University of California, San Diego.

"However, our study showed that African-American men who underwent active surveillance instead of immediate treatment were not more likely to have their cancer spread or to die from the disease," he told Reuters Health by email.

Dr. Rose and colleagues compared clinical outcomes of 2,280 Black men (mean age, 63.2 years) and 6,446 non-Hispanic white men (mean age, 65.5 years) with low-risk prostate cancer managed with active surveillance. Low-risk prostate cancer was defined as a Gleason score of 6 or less, clinical tumor stage of 2A or less and prostate-specific antigen (PSA) level of 10 ng/dL or less.

At 10 years, Black men had significantly higher rates of disease progression (59.9% vs. 48.3%) and definitive treatment (54.8% vs. 41.4%), but there were no significant differences in development of metastases (1.5% vs. 1.4%, respectively) or prostate-cancer-specific mortality (1.1% vs. 1.0%) or all-cause mortality (22.4% vs. 23.5%).

"It's important to note that active surveillance needs to be done carefully since African-American men were more likely to need treatment at some point in their life. If patients aren't followed carefully it is possible that they could have disease progression and miss the opportunity to cure the cancer," Dr. Rose told Reuters Health.

The authors of a linked editorial stress that, "While these findings suggest that active surveillance can be safe and effective for Black men, a cautionary note must be raised regarding generalizing results from the equal-access VHA medical centers to more common care contexts."

"Whether Black men and White men with low-risk prostate cancer receiving active surveillance have similarly good outcomes in the general population remains unknown," write Dr. Ronald Chen of the University of Kansas Medical Center, in Kansas City, and co-authors.

"Further reassurance would be gained from research showing similar outcomes in broader general population settings outside of the VHA context. Until such evidence is available, concerns about biologic differences in prostate cancer between Black and White men and potential disparities in receiving timely surveillance monitoring and treatment on cancer progression may continue to drive lower rates of active surveillance use among Black patients," they conclude.

By Megan Brooks

SOURCE: https://bit.ly/364aMNE JAMA, online November 3, 2020.

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