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Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance.

Publication ,  Journal Article
Deka, R; Courtney, PT; Parsons, JK; Nelson, TJ; Nalawade, V; Luterstein, E; Cherry, DR; Simpson, DR; Mundt, AJ; Murphy, JD; D'Amico, AV ...
Published in: JAMA
November 2020

There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men.To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance.Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020.Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy.Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer-specific mortality, and all-cause mortality.The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .49); of prostate cancer-specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, -0.9% to 3.1%]; P = 0.09).In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer-specific mortality. Longer-term follow-up is needed to better assess the mortality risk.

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Published In

JAMA

DOI

EISSN

1538-3598

ISSN

0098-7484

Publication Date

November 2020

Volume

324

Issue

17

Start / End Page

1747 / 1754

Related Subject Headings

  • White People
  • Watchful Waiting
  • Risk
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostate
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Deka, R., Courtney, P. T., Parsons, J. K., Nelson, T. J., Nalawade, V., Luterstein, E., … Rose, B. S. (2020). Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA, 324(17), 1747–1754. https://doi.org/10.1001/jama.2020.17020
Deka, Rishi, P Travis Courtney, J Kellogg Parsons, Tyler J. Nelson, Vinit Nalawade, Elaine Luterstein, Daniel R. Cherry, et al. “Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance.JAMA 324, no. 17 (November 2020): 1747–54. https://doi.org/10.1001/jama.2020.17020.
Deka R, Courtney PT, Parsons JK, Nelson TJ, Nalawade V, Luterstein E, et al. Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA. 2020 Nov;324(17):1747–54.
Deka, Rishi, et al. “Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance.JAMA, vol. 324, no. 17, Nov. 2020, pp. 1747–54. Epmc, doi:10.1001/jama.2020.17020.
Deka R, Courtney PT, Parsons JK, Nelson TJ, Nalawade V, Luterstein E, Cherry DR, Simpson DR, Mundt AJ, Murphy JD, D’Amico AV, Kane CJ, Martinez ME, Rose BS. Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA. 2020 Nov;324(17):1747–1754.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

ISSN

0098-7484

Publication Date

November 2020

Volume

324

Issue

17

Start / End Page

1747 / 1754

Related Subject Headings

  • White People
  • Watchful Waiting
  • Risk
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostate
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine