Time to Rethink Active Surveillance in African American Men With Prostate Cancer

The study revealed that African American men with Gleason score 3 + 3 = 6 prostate cancer produce less PSA than Caucasian men. African American and Caucasian men had equal serum PSA and PSAM despite significantly larger prostates in African American men (approximately 10 gm larger). PSAD was approximately 20% lower in African American men compared to Caucasian men even when tumor volume was the same.

“Both PSA and its derivative PSAD are the criteria in selecting men for active surveillance. This study shows an unequivocal evidence of lower PSA production and, consequentially, lower PSA density in African American men. Thus, either African American men need to be counseled that active surveillance criteria are less reliable for them or new race-specific criteria have to be developed,” Dr Kryvenko told Cancer Therapy Advisor.

In a previously published study, he and his colleagues found that African American men with very low-risk prostate cancer at diagnosis had a significantly higher prevalence of anterior cancer foci, which were of higher grade and larger volume.²

Dr Kryvenko said African Americans overall not only have a higher grade cancer at radical prostatectomy, but also their spatial distribution of cancer in prostate is such that standard prostate biopsy may under sample more aggressive tumor nodules.

Gerald Andriole, MD, chief of the Division of Urologic Surgery at Washington University School of Medicine in St. Louis, MO, said this very careful analysis suggested that different PSA criteria should be used when assessing African American men with low-risk prostate cancer. However, he noted that replication of these findings in larger studies would be worthwhile.

“In the meantime, other criteria that are also used to assess the significance of low risk prostate cancer, such as multiparametric magnetic resonance imaging scans, should be evaluated in various populations of men. These studies are crucial as the medical community begins to embrace active surveillance for men. We must avoid inappropriate under treatment of men,” Andriole told Cancer Therapy Advisor.

References

1. Kryvenko ON, Balise R, Prakash NS, Epstein JI.  African American men with Gleason Score 3+3=6 prostate cancer produce less PSA than Caucasian men: a potential impact on active surveillance. J Urol. 2016;195(2):301-306.
2. Sundi D, Kryvenko ON, Carter HB, et al. Pathological examination of radical prostatectomy specimens in men with very low risk disease at biopsy reveals distinct zonal distribution of cancer in black American men. J Urol. 2014;191(1):60-67.