Elsevier

Urology

Volume 73, Issue 3, March 2009, Pages 620-623
Urology

Oncology
Does Race Affect Postoperative Outcomes in Patients With Low-Risk Prostate Cancer Who Undergo Radical Prostatectomy?

https://doi.org/10.1016/j.urology.2008.09.035Get rights and content

Objectives

To assess the magnitude of racial disparities in prostate cancer outcomes following radical prostatectomy for low-risk prostate cancer.

Methods

We retrospectively reviewed our database of 2407 patients who under went radical prostatectomy and isolated 2 cohorts of patients with low-risk prostate cancer. Cohort 1 was defined using liberal criteria, and cohort 2 was isolated using more stringent criteria. We then studied pre- and postoperative parameters to discern any racial differences in these 2 groups. Statistical analyses, including log-rank, χ2, and Fisher's exact analyses, were used to ascertain the significance of such differences.

Results

Preoperatively, no significant differences were found between the white and African-American patients with regard to age at diagnosis, mean prostate-specific antigen, median follow-up, or percentage of involved cores on prostate biopsy. African-American patients in cohort 1 had a greater mean body mass index than did white patients (26.9 vs 27.8, P = .026). The analysis of postoperative data demonstrated no significant difference between white and African-American patients in the risk of biochemical failure, extraprostatic extension, seminal vesicle involvement, positive surgical margins, tumor volume, or risk of disease upgrading. African-American patients in cohort 2 demonstrated greater all-cause mortality compared with their white counterparts (9.4% vs 3.1%, P = .027).

Conclusions

In patients with low-risk prostate cancer treated with radical prostatectomy, there exist no significant differences in surrogate measures of disease control, risk of disease upgrading, estimated tumor volume, or recurrence-free survival between whites and African-Americans.

Section snippets

Material and Methods

We retrospectively reviewed the data from 2407 consecutive patients who had undergone radical retropubic prostatectomy at our institution from 1991 to 2007. We defined 2 cohorts of low-risk patients, 1 using liberal criteria (cohort 1), defined as those with a PSA level of ≤15 ng/mL, Gleason score ≤6, clinical Stage T1 or T2, and 1 or 2 positive cores on prostate needle biopsy, and the second using stringent criteria (cohort 2), defined as those with a PSA level ≤10 ng/mL, Gleason score ≤6,

Results

A total of 648 white and 91 African-American patients were included in cohort 1 and 354 white and 53 African-American patients were included in the cohort 2. No significant differences were found between white and African-American patients in age at diagnosis, mean PSA level, median follow-up, or percentage of biopsy cores involved with adenocarcinoma in either cohort. The only significant difference in preoperative characteristics was a greater mean body mass index for African-American

Comment

The introduction and widespread implementation of PSA screening for prostate cancer has resulted in a significant shift to the diagnosis of low-risk disease in younger men. Although risk stratification schemes such as those proposed by D'Amico et al.14 and the Memorial Sloan-Kettering group15 are helpful in counseling patients with regard to their risk of recurrence after treatment, few data are available to guide clinicians in counseling patients regarding the true risk of death from prostate

Conclusions

In our experience with patients with low-risk prostate cancer who underwent radical prostatectomy, no significant difference was found in prostate cancer-specific measures of disease control, risk of disease upgrading, estimated tumor volume, or recurrence-free survival between white and African-American men. Taken together, these data suggest that, despite the well-documented racial disparities in prostate cancer epidemiology and outcomes, no evidence exists that low-risk African-American

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  • Cited by (0)

    This research was supported by the Linda and Joel Appel Prostate Cancer Research Fund.

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