MP48-09 GRADE RECLASSIFICATION IN ACTIVE SURVEILLANCE FOR AFRICAN AMERICAN MEN WITH VERY LOW RISK PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (MP48)1 Apr 2019MP48-09 GRADE RECLASSIFICATION IN ACTIVE SURVEILLANCE FOR AFRICAN AMERICAN MEN WITH VERY LOW RISK PROSTATE CANCER Demetrios Simopoulos*, Patricia Landis, Jonathan Epstein, H. Ballentine Carter, Michael Gorin, and Mufaddal Mamawala Demetrios Simopoulos*Demetrios Simopoulos* More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , H. Ballentine CarterH. Ballentine Carter More articles by this author , Michael GorinMichael Gorin More articles by this author , and Mufaddal MamawalaMufaddal Mamawala More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556410.70398.d9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Previous studies have shown racial disparity in the epidemiology of prostate cancer (PCa) for African American (AA) men, creating a dilemma whether these men should be enrolled in active surveillance (AS). We sought to assess the risk of grade reclassification (GR) to grade group (GG) ≥2 and ≥3 in AA men, compared with a non-AA cohort, meeting the criteria for an indolent disease and otherwise ideal candidates for AS. METHODS: Between 1995-2018, we retrospectively identified 1,312 men with GG 1 (Gleason Score [GS] 6) cancer meeting the criteria for very low risk PCa (<3 cores positive, <50% maximum cancer involvement in any positive core and PSA density [PSAD] <0.15) at diagnosis, from the Johns Hopkins AS registry. Out of 1,312 men (median follow-up 4 years [IQR 2-7]), 103 men were AA while 1209 men were non-AA (97% Caucasian). Among AA men 22% had MRI targeted biopsies compared to 21% in non-AA men. Rates of GR to GG ≥2 (GS ≥3+4) and ≥3 (GS ≥4+3) were evaluated using survival analysis. RESULTS: The median number of biopsies was 3 (IQR 2-5) for both race groups and the median interval between biopsies was 45 months for AA men vs. 51 months for non-AA men (p=0.1). Thirty-one AA-men and 230 non-AA men had GR to GG ≥2. In men with GR, AA men were more likely to be upgraded to GG ≥3 compared to non-AA men (45% [14/31] vs 31% [72/230], p=0.03). On Kaplan-Meir analysis the 2, 5 and 10-year GR free survival in AA men vs. non-AA men was 84%, 69% and 50% vs. 90%, 81% and 70%, respectively for GR to GG ≥2 (p=0.002), and 92%, 83% and 78% vs. 97%, 94% and 91%, respectively for GR to GG ≥3 (p=0.001) (Figure). Upon adjusting for PSAD, age and year of diagnosis, AA men remained at a significantly higher risk of GR to GG ≥2 (HR=1.9, 95% CI [1.3-2.8]; p=0.001) and GG ≥3 (HR=2.6, 95% CI [1.4-4.7], p=0.002) as compared to non-AA men. CONCLUSIONS: African-American men meeting even the most stringent AS criteria have a relatively higher risk of harboring occult cancer foci of an aggressive phenotype compared to similar non-African-American men. Offering AS to these men should be approached with greater caution and, if enrolled, AA men should be closely followed. Source of Funding: None Baltimore, MD© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e700-e700 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Demetrios Simopoulos* More articles by this author Patricia Landis More articles by this author Jonathan Epstein More articles by this author H. Ballentine Carter More articles by this author Michael Gorin More articles by this author Mufaddal Mamawala More articles by this author Expand All Advertisement PDF downloadLoading ...