For African American Men, Active Surveillance May Be Risky
Aggressive Cancer May be Missed
If you are an African American man, you should take prostate cancer very seriously because, unfortunately, your life may depend on it. No other group of men in the world shares your risk of getting prostate cancer, of getting the kind that needs to be treated, of having it diagnosed at a later stage, and of dying from it. Now, important research by Brady investigators has shown that even the "best" kind of prostate cancer – the kind that seems to be very low-risk, the kind that could be treated with active surveillance – may not be as benign in African American men.
To find out, Schaeffer, along with colleagues including H. Ballentine Carter, Debasish Sundi, and Ashley Ross, recently studied 1,801 men who met the National Comprehensive Cancer Network’s criteria for very low-risk prostate cancer. These men were candidates for active surveillance but elected to undergo immediate prostatectomy instead. The groups consisted of 256 African American men, 1,473 white men, and 72 men of other races. The team investigated pathologic and cancer-specific outcomes in these men, and the results were striking: "Surprisingly," says Schaeffer, "African American men had threefold higher rates of more advanced, aggressive disease, which resulted in much poorer outcomes, compared to white men." In other words, even though these men had been considered at very low risk, their cancer turned out to be more aggressive and more extensive than the initial biopsy and physical exam had suggested.
This work, published in the Journal of Clinical Oncology, prompted Schaeffer to team up with renowned prostate pathologist Jonathan Epstein for further investigation. In studying the prostatectomy specimens from these men, Epstein found that, compared to Caucasian men, the tumors in African American men were larger, of higher grade, and more likely to appear in harder-to-diagnose areas of the prostate. These findings, published in the Journal of Urology, showed that African American men had high-grade cancers at the top of the prostate – an area that is farthest from the rectum – nearly 60 percent of the time .