Active Surveillance of Prostate Cancer in African American Men
Oakland, CA July 18, 2013. Dennis R. Hill M.D. Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA reports that although active surveillance of biopsy proven low risk prostate cancer is an alternative to immediate treatment it is a long term commitment. Active surveillance programs typically require PSA and digital rectal exams every three months and potential re-biopsy annually. Although the cancer will not go away, the rationale is that the pace of disease can be determined and treatment may not be required for the man’s remaining natural life. More men are choosing this option rather than proceeding to surgery, radiation therapy, permanent seed implant or high dose rate brachytherapy. Dr. Hill has always recommended active surveillance in elderly patients or patients with other serious illness which may overtake them before the prostate cancer. However there is new evidence that active surveillance may be more risky for African American men. The study was published online June 17 in the Journal of Clinical Oncology. http://jco.ascopubs.org/content/early/2013/06/17/JCO.2012.47.0302
Dr. Hill notes that the study authors report that black men with very-low-risk disease are more likely than their white counterparts to actually have more aggressive disease. They retrospectively looked at 256 black and 1473 white very-low-risk patients who nonetheless underwent radical prostatectomy at Johns Hopkins University in Baltimore, Maryland. It is the largest cohort to date of black men who qualify for active surveillance, according to senior author Edward Schaeffer, MD, and colleagues from Hopkins. They found that the black men had significantly higher rates of upgrading at surgery than their white counterparts (27.3% vs 14.4%), and more adverse pathology (i.e., high-risk disease) (14.1% vs 7.7%). The men in the study were culled from a group of 19,142 men who underwent radical prostatectomy at The Johns Hopkins Hospital from 1992 and 2012. The 1801 men selected for study inclusion had very-low-risk disease, according to National Comprehensive Cancer Network criteria. They had a clinical-stage disease of T1c or less, a biopsy Gleason score of 6 or less, no more than 2 positive biopsy cores, core involvement of 50% or less, a prostate-specific antigen (PSA) level below 10 ng/mL, and a PSA density of 0.15 ng/mL per cm³ or less. In previous studies of men managed with active surveillance, results for cancer-related outcome by race have been mixed but this is by far the largest study.
Since the calculated gamble of using active surveillance to manage very-low-risk prostate cancer appears to be more uncertain for black men, Dr Hill agrees with the authors that “African American men with very-low-risk prostate cancer should be counseled about increased oncologic risk when deciding among their disease management options.”
Dr. Hill has been doing High Dose Rate Brachytherapy exclusively since 2004. He has done over five hundred High Dose Rate Prostate Brachytherapy implants and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com, which includes a quiz to determine if a patient is a candidate for HDR Prostate Brachytherapy.