A new study suggests that African American men with low-risk prostate cancer may not do as well on an active surveillance approach as Caucasian men. Researchers found that African American men who had their prostates removed soon after being diagnosed with low-risk cancer were more likely to have the severity of their cancer upgraded based on a doctor’s second look, compared to their white counterparts. “It’s known that outcomes for African Americans with prostate cancer are less good. That’s a known fact,” said Dr. Edward Schaeffer, the study’s senior author from Johns Hopkins Hospital in Baltimore. “This study’s number one highlight is that because of that observation, we don’t think you should just recommend active surveillance,” he told Reuters Health.
About 20 percent of cancers are very low-risk and it’s recommended that doctors use “active surveillance” among men who are expected to live for less than 20 years, write Schaeffer and his colleagues in the Journal of Clinical Oncology.
With active surveillance, the prostate cancer is closely monitored but not treated. That allows men to avoid the potential side effects of radiation and surgery, such as incontinence and impotence. It also gives doctors a chance to intervene if the cancer worsens. But the data used to advise doctors on who the best candidates are for active surveillance are based on studies that included mostly white men. Therefore, the guidelines may not apply to African American men, who are known to have worse prostate cancer outcomes, researchers said.
For the new study, Schaeffer and his colleagues analyzed data on 256 African American men, 1,473 white men and 72 men of other races who were diagnosed with very low-risk prostate cancer after 1992. The men all had their prostates surgically removed at Johns Hopkins Hospital soon after they were diagnosed.
The researchers then looked at what doctors actually found when they removed the men’s prostates and whether there were any differences in cancer characteristics between white men and African American men. Overall, about 27 percent of African American men ended up having more server cancers than doctors originally thought, compared to about 14 percent of white men.
Researchers also found more African American men had cancers that were likely to return after they were removed. What’s more, additional research from Schaeffer and his colleagues, published in The Journal of Urology, found that African American men tend to have larger tumors located in areas of the prostate that are harder for doctors to biopsy. “If you have an African American man with very low-risk prostate cancer, our recommendation at this time is that they strongly consider a MRI of their prostate (to look for these tumors),” Schaeffer said.
Theresa W. Gillespie, who was not involved in this study, but has extensively studied prostate cancer in African American men, said the new study alone won’t change existing treatment guidelines. “We need to have more African Americans involved in research. All of the studies that were cited… the number of African Americans involved in those studies … are very small numbers,” Gillespie, from the Emory University School of Medicine in Atlanta, told Reuters Health.
Schaeffer said the new findings need to be validated in other groups and that his team is currently working on additional research.
As always, patient empowerment through knowledge is always the goal. That can only happen with information. If you have concerns, especially if you are African American, ask your physician for a PSA test so you can have that information and then make the best decision for your particular case.