ACTIVE SURVEILLANCE CHALLENGING IN BLACK MEN WITH PROSTATE CANCER

African-American men with a new diagnosis of prostate cancer may want to think twice about putting off active treatment in favor of active surveillance, a research review suggests.

The researchers reviewed 43 previously published studies of active surveillance that explored how well this approach works for African-American men. They found mixed results; some studies suggested these men who chose active surveillance later had more advanced and difficult to treat tumors but other studies showed no difference in outcomes based on race.

Part of the problem is that too few studies include enough African-American men to offer a clear picture of how their cancer outcomes might differ from other patients, said senior study author Dr. Curtis Pettaway of the University of Texas M.D. Anderson Cancer Center in Houston.

“Increased prostate cancer mortality among black men in the United States is likely caused by many factors including an aggressive disease biology which is likely controlled in part by the expression of genes that may differ between white and black men, delay in diagnosis related to access to medical care which may lead to advanced (cancer) at (diagnosis), and differences in treatment received,” Pettaway said by email.

Some small studies included in the research review of men who were eligible for active surveillance but opted for aggressive treatment found that black men were more likely to have more advanced or high risk tumors than white men.

“Clinical staging among African-American men may be even more imprecise as those African-American men who were thought to have good risk disease but underwent surgery were found to have more adverse features than comparable Caucasian men,” Pettaway said. In particular, the black men were more likely to have anterior prostate tumors that aren't always checked with biopsies, Pettaway added.

The research review didn’t include a pooled analysis of data from several smaller studies, the authors note in their paper in Prostate Cancer and Prostatic Diseases online April 18. As a result, it didn’t offer fresh statistics on survival odds or other cancer outcomes.

“It is important to emphasize that active surveillance is not ‘doing nothing’ and if men are classified to higher risk disease and offered treatment, it is expected that they are within the window for cure,” said Dr. Behfar Ehdaie, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York.

“I do not believe any studies conducted on African-American men managed with active surveillance suggest any findings contrary to this central idea,” Ehdaie, who wasn’t involved in the study, said by email.

To avoid the potential that clinical staging might be initially wrong, African-American men may need additional tests like a biopsy or MRI to confirm they’re good candidates for active surveillance before they choose this option, said Dr. James Dupree, a urology researcher at the University of Michigan in Ann Arbor who wasn’t involved in the study.

“Many centers are instituting those confirmatory tests for all men considering active surveillance,” Dupree said by email.