Impact of Race on Prostate-Specific Antigen Outcome After Radical Prostatectomy for Clinically Localized Adenocarcinoma of the Prostate

PURPOSE: To compare prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for prostate cancer in African-American and white men using previously established risk groups. PATIENTS AND METHODS: Between 1989 and 2000, 2,036 men (n = 162 African-American men, n = 1,874 white men) underwent RP for clinically localized prostate cancer. Using pretreatment PSA, Gleason score, clinical T stage, and percentage of positive biopsy specimens, patients were stratified into low- and high-risk groups. For each risk group, PSA outcome was estimated using the actuarial method of Kaplan and Meier. Comparisons of PSA outcome between African-American and white men were made using the log-rank test. RESULTS: The median age and PSA level for African-American and white men were 60 and 62 years old and 8.8 and 7.0 ng/mL, respectively. African-Americans had a statistically significant increase in PSA (P = .002), Gleason score (P = .003), clinical T stage (P = .004), and percentage of positive biopsy specimens (P = .04) at presentation. However, there was no statistical difference in the distribution of PSA, clinical T stage, or Gleason score between racial groups in the low- and high-risk groups. The 5-year estimate of PSA outcome was 87% in the low-risk group for all patients (P = .70) and 28% versus 32% in African-American and white patients in the high-risk group (P = .28), respectively. Longer follow-up is required to confirm if these results are maintained at 10 years. CONCLUSION: Even though African-American men presented at a younger age and with more advanced disease compared with white men with prostate cancer, PSA outcome after RP when controlled for known clinical predictive factors was not statistically different. This study supports earlier screening in African-American men.

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The national impact of the COVID-19 pandemic on U.S. prostate cancer community care.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.5061 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 5061-5061

Author(s):

Matthew R. Cooperberg ◽

Paul Brendel ◽

Daniel J. Lee ◽

Rahul Doraiswami ◽

Hariesh Rajasekar ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Language Processing ◽

Care Delivery ◽

Specific Antigen ◽

Risk Groups ◽

Low Risk ◽

T Stage ◽

Risk Stratum ◽

The Impact

5061 Background: We used data from a specialty-wide, community-based urology registry to determine trends in outpatient prostate cancer (PCa) care during the COVID-19 pandemic. Methods: 3,165 (̃ 25%) of US urology providers, representing 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry, which collects data via automated extraction from electronic health record systems. We analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. Risk stratification was based on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage, and we used a natural language processing algorithm to determine Gleason and T-stage from unstructured clinical notes. The primary outcome was mean weekly visit volume by PCa patients per practice (visits defined as all MD and mid-level visits, telehealth and face-to-face), and we compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019. Results: There were 267,691 PCa patients in AQUA who received care between 2019 and 2020. From mid-March to early November, 2020 (week 10 – week 44) the magnitude of the decline and recovery varied by risk stratum, with the steepest drops for low-risk PCa (Table). For 2020, overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks (̃25). Visits declined to week 14 (18.19; a 31% drop from 2019), recovered to 2019 levels by week 23, and declined steadily to 11.89 (a 58% drop from 2019) as of week 44, the cut off of this analysis. Conclusions: Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November. This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely.[Table: see text]

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Presenting stage and risk group in men dying of prostate cancer

Current Oncology ◽

10.3747/co.27.6385 ◽

2020 ◽

Vol 27 (6) ◽

Author(s):

S. Parimi ◽

S. Bondy ◽

M. Aparicio ◽

K. Sunderland ◽

J. Cho ◽

...

Keyword(s):

Prostate Cancer ◽

British Columbia ◽

High Risk ◽

Gleason Score ◽

Metastatic Disease ◽

Risk Group ◽

Specific Antigen ◽

Population Based ◽

Low Risk ◽

Intermediate Risk

Introduction Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains uncertain whether treatment of cases that can be treated with curative intent alters the mortality rate. There are very few studies describing the presenting stage, risk groups, and survival after diagnosis for men dying of prostate cancer in the literature. In this study, we explored these characteristics for all men who died of prostate cancer in British Columbia between 2013 and 2015. Methods The population-based BC Cancer databases were used to identify all patients diagnosed between January 2013 and December 2015 who died of prostate cancer. Patient, tumour, and treatment characteristics were collected, and the risk grouping for each tumour was determined. The proportion of cases in each risk group at the time of diagnosis was determined. Survival time from diagnosis to death was calculated for all patients and for each risk group using the Kaplan–Meier method. Results A total of 1256 patients died of prostate cancer. Of patients who presented with metastatic disease, 57.2% presented with a Gleason score of 8 or more, compared with only 35.7% of patients who presented with nonmetastatic disease (p < 0.0001). The presenting stage and risk group of those dying of prostate cancer were as follows: 32% metastatic disease, 3% regional (defined as node-positive), 39% localized high risk, 9% localized intermediate risk, 4% localized low risk, 6% localized not otherwise specified, and 7% unknown. Therefore, 80.3% of those with a known risk group presented with either localized high-risk, regional, or metastatic disease at diagnosis. The median survival times from diagnosis to death were 12 years for localized low-risk, 10 years for localized intermediate-risk, 6.5 years for localized high-risk, 4 years for regional, and 1.7 years for metastatic disease at diagnosis. Conclusions This population-based analysis demonstrates that patients with localized high-risk, regional, or metastatic disease at diagnosis constitute the overwhelming majority of patients who die of prostate cancer in British Columbia. Unless these disease states can reliably be identified at an earlier low- or intermediate-risk localized state in the future, it is unlikely that treatment of localized low- and intermediate-risk cancer will have an impact on survival. Furthermore, patients with de novo metastatic disease had identifiable risk factors of a higher prostate-specific antigen and Gleason score. Further studies are required to confirm these results.

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Marijuana use history in patients presenting with localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.129 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 129-129

Author(s):

Romaine Charles Nichols ◽

Christopher G Morris ◽

Curtis Bryant ◽

Bradford S. Hoppe ◽

Randal H. Henderson ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Risk Group ◽

Specific Antigen ◽

Positive Association ◽

Marijuana Use ◽

Localized Prostate Cancer ◽

Significant Positive Association ◽

Clinical Risk ◽

T Stage

129 Background: Determine the incidence of past marijuana use in a large cohort of men diagnosed with localized prostate cancer to determine if marijuana use was correlated with: patient age; pretreatment T stage; Prostate specific antigen (PSA); Gleason Score; or clinical risk group. Methods: From August, 2006 to October 2018, 4305 patients received treatment for localized prostate cancer and are included in an outcomes tracking protocol. All patients were requested to complete a pre treatment information form which included the question: “Have you ever used marijuana?” 4277 (97%) answered the question either affirmatively or negatively. Responses were stratified by: patient birth year; clinical T stage, PSA level; highest Gleason score; and clinical risk group. Results: 3.8% of men born before 1940 reported marijuana use compared to 17.4% born between 1940 and 1950 and 38.6% born after 1950 (p<0.0001). 19.8% of men with T1 tumors reported marijuana use compared to 18.1% of men with T2 tumors and 19.1% of men with T3 tumors (p=0.4494). 19.7% of men with a PSA less than 10 ng/ml reported marijuana use compared to 17.2% of men with a PSA between 10 and 20 ng/ml and 18.7% of men with a PSA over 20 ng/ml (p=0.4029). 20.8% of men with Gleason score of 6 or less reported marijuana use compared to 19.6% of men with a Gleason score of 7 and 13.5% with Gleason score of 8 or higher (p=0.0004). 20.8% of men with low risk presentation reported marijuana use compared to 19.9% of men with intermediate risk presentation and 14.1% of men with high risk presentation (p=0.0004). There was a significant positive association observed between increasing age and Gleason score (p<0.0001). Conclusions: Men presenting with higher Gleason score tumors and higher risk disease were significantly less likely to report past marijuana use. It is likely that this finding is due to the greater incidence of high grade tumors seen in older patients.

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Age dependence of modern clinical risk groups for localized prostate cancer – a population-based study

10.1101/648519 ◽

2019 ◽

Author(s):

Minh-Phuong Huynh-Le ◽

Tor Åge Myklebust ◽

Christine H. Feng ◽

Roshan Karunamuni ◽

Tom Børge Johannesen ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Gleason Score ◽

Risk Group ◽

Risk Groups ◽

Low Risk ◽

Intermediate Risk ◽

Clinical Risk ◽

High Risk Disease ◽

Clinical Risk Groups

AbstractBackgroundOptimal prostate cancer (PCa) screening strategies will focus on men most likely to have potentially-lethal, localized disease. Age-specific incidence rates (ASIRs) for clinical risk groups could guide risk-stratified screening.ObjectiveDetermine ASIRs and proportions of PCa diagnoses in Norway for modern risk-group and Gleason score categories.Design, Setting, and ParticipantsAll men diagnosed with PCa in Norway in 2014-2017 (n=20,356).Outcome Measurements and Statistical AnalysisPatients were assigned to clinical risk groups: low, favorable-intermediate, unfavorable-intermediate, high, regional, and metastatic, using Gleason score and clinical stage. Associations were assessed between age and (1) Gleason score (including Gleason 3+4 and 4+3) and (2) PCa risk group. Risk-group ASIRs were calculated by multiplying the overall Norwegian ASIR by the proportions observed for each category.ResultsOlder age was significantly associated with higher Gleason score and more advanced disease. For example, among men aged 55-59, 65-69, 75-79, and 85-89 years, the percentage with Gleason 8-10 disease was 16.5%, 23.4%, 37.2%, and 59.9%, respectively (p<0.001); the percentage with at least high-risk disease was 29.3%, 39.1%, 60.4%, and 90.6%, respectively. Corresponding percentages for low-risk PCa were 24.0%, 17.9%, 10.2%, and 4.1% (p<0.001). The respective maximum ASIRs (per 100,000 men) for low-risk, favorable-intermediate-risk, unfavorable-intermediate-risk, high-risk, regional, and metastatic disease were: 157.1, 183.8, 194.8, 408.3, 172.3, and 330.0; incidence for low-risk and favorable-intermediate-risk PCa peaked before age 70, while more advanced categories peaked after 70. At age 75-79 years, the ASIR of high-risk disease was approximately 6 times greater than at 55-59 years.ConclusionsRisk of clinically-significant, localized PCa increases with age. Healthy older men may be among those most likely to benefit from PCa screening.

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African-American Men with Gleason Score 3+3=6 Prostate Cancer Produce Less Prostate Specific Antigen than Caucasian Men: A Potential Impact on Active Surveillance

The Journal of Urology ◽

10.1016/j.juro.2015.08.089 ◽

2016 ◽

Vol 195 (2) ◽

pp. 301-306 ◽

Cited By ~ 14

Author(s):

Oleksandr N. Kryvenko ◽

Raymond Balise ◽

Nachiketh Soodana Prakash ◽

Jonathan I. Epstein

Keyword(s):

Prostate Cancer ◽

African American ◽

Prostate Specific Antigen ◽

Active Surveillance ◽

Gleason Score ◽

African American Men ◽

Specific Antigen ◽

Caucasian Men ◽

Potential Impact

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1267: Prostate-Specific Antigen Velocity among African-American and White Men Without Prostate Cancer

The Journal of Urology ◽

10.1016/s0022-5347(18)38492-1 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 334-334

Author(s):

Walter J. Simoneaux ◽

Caleb B. Bozeman ◽

Brett S. Carver ◽

Donald A. Elmajian

Keyword(s):

Prostate Cancer ◽

African American ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

White Men

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Religious Involvement and Prostate Cancer Screening Behaviors Among Southeastern African American Men

American Journal of Men s Health ◽

10.1177/1557988308318686 ◽

2008 ◽

Vol 3 (3) ◽

pp. 214-223 ◽

Cited By ~ 15

Author(s):

Cheryl L. Holt ◽

Theresa A. Wynn ◽

Jasmine Darrington

Keyword(s):

Prostate Cancer ◽

African American ◽

Cancer Screening ◽

African American Men ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Religious Involvement ◽

Educational Interventions ◽

Religious Behaviors

This study examined the relationship between religious involvement and prostate cancer screening behavior among a probability sample of 199 African American men. Religious involvement was assessed by telephone via a multidimensional instrument. Engaging in religious behaviors was predictive of reporting a digital rectal examination (DRE) within the past year. Religious beliefs and behaviors were predictive of behavioral intention for DRE in the next 6 months. Religious behaviors were predictive of reporting an appointment for a DRE in the next 6 months. All analyses were controlled for age, education, and marital status. None of the predictions were significant for prostate-specific antigen testing. Understanding the role of religious involvement in cancer beliefs and screening is important. Such knowledge can inform educational interventions for this group, which is disproportionately affected by prostate cancer.

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