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Kamel MH, Bimali M, Khalil MI, Eltahawy E, Su LJ, Bissada NK, Davis R. Regional trends in average years of potential life lost (AYPLL) secondary to prostate cancer deaths among Caucasians and African Americans treated by surgery or radiation. Int Urol Nephrol 2019; 51:561-569. [PMID: 30840195 DOI: 10.1007/s11255-019-02116-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To study regional trends in average years of potential life lost (AYPLL) among Caucasians (CA) and African Americans (AA) with prostate cancer (Pca) who received radical prostatectomy or radiation therapy among four different regions in the US as well as across different tumor grades. Years of potential life lost is defined as the difference between a predetermined end-point age and the age at death for a death that occurred prior to that end age, hence the AYPLL is calculated by dividing the total YPLL by the total number of patients died. METHODS The surveillance epidemiology and end results (SEER) database was used to identify Pca patients who were CA or AA and who have received radical prostatectomy or radiation therapy. Study duration was divided into four decades; 1973-1982 (D1), 1983-1992 (D2), 1993-2002 (D3), 2003-2012 (D4). Examined regions were; North East (NE), North central (NC), South and West. Tumor grade was classified into; well/moderately differentiated (WD/MD) and poorly/undifferentiated (PD/UD) groups. Differences in AYPLL among CA and AA in each of these variables were compared. RESULTS Overall, compared to CA, AA were diagnosed and died earlier from Pca. AA had higher AYPLL to Pca than CA. In both tumor grade groups, progressive increase in AYPLL among AA compared to CA was noted over the last three decades. In the WD/MD group, except for the South region, the highest recorded difference in AYPLL between AA and CA was in D4. In the PD/UD group, a similar difference in AYPLL between AA and CA was noted in all regions. The difference in AYPLL was higher in the PD/UD group than the WD/MD group. CONCLUSIONS Racial disparity between AA and CA existed across the examined regions. It is more pronounced in advanced tumor grades. The differences were more significant in the last decade.
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Affiliation(s)
- Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA. .,Department of Urology, Ain Shams University, Cairo, Egypt.
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ehab Eltahawy
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - LJoseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nabil K Bissada
- Department of Urology, Baylor School of Medicine and Michael E. De Bakey VA Medical center, Houston, TX, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
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2
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Everist MM, Howard LE, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Terris MK, Freedland SJ. Socioeconomic status, race, and long-term outcomes after radical prostatectomy in an equal access health system: Results from the SEARCH database. Urol Oncol 2018; 37:289.e11-289.e17. [PMID: 30598238 DOI: 10.1016/j.urolonc.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We previously found racial differences in biochemical recurrence (BCR) after radical prostatectomy (RP) persisted after adjusting for socioeconomic status (SES) while SES did not predict BCR. The impact on long-term prostate cancer (PC) outcomes is unclear. We hypothesized higher SES would associate with better long-term outcomes regardless of race. METHODS Among 4,787 black and white men undergoing RP from 1988 to 2015 in the SEARCH Database, poverty (primary SES measure) was estimated by linking home ZIP-code to census data. Cox models were used to test the association between SES adjusting for demographic, clinicopathological features, and race with BCR, castration-resistant PC (CRPC), metastases, PC-specific mortality (PCSM), and all-cause mortality. Interactions between race and SES were tested. RESULTS Median follow-up was 98 months (Interquartile range: 54-150 months). There were no interactions between race and SES for BCR. Black men had 10%- to 11% increased BCR risk (P < 0.06) while SES was unrelated to BCR. There were interactions between SES and race for CRPC (P = 0.002), metastasis (P = 0.014), and PCSM (P = 0.004). Lower SES was associated with decreased CRPC (P = 0.012), metastases (P = 0.004), and PCSM (P = 0.049) in black, but not white men (all P ≥ 0.22). Higher SES was associated with decreased all-cause mortality in both races. CONCLUSIONS In an equal-access setting, lower SES associated with decreased CRPC, metastases, and PCSM in black but not white men. If confirmed, these findings suggest a complex relationship between race, SES, and PC with further research needed to understand why low SES in black men decreased the risk for poor PC outcomes after RP.
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Affiliation(s)
- Mary M Everist
- Division of Urology, Veterans Affairs Medical Center, Durham, NC
| | - Lauren E Howard
- Division of Urology, Veterans Affairs Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - William J Aronson
- Department of Urology, UCLA School of Medicine, Los Angeles, CA; Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Christopher J Kane
- Urology Department, University of California San Diego Health System, San Diego, CA
| | | | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, GA; Section of Urology, Medical College of Georgia, Augusta, GA
| | - Stephen J Freedland
- Division of Urology, Veterans Affairs Medical Center, Durham, NC; Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
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3
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Increased frequency of germline BRCA2 mutations associates with prostate cancer metastasis in a racially diverse patient population. Prostate Cancer Prostatic Dis 2018; 22:406-410. [PMID: 30542053 PMCID: PMC6760554 DOI: 10.1038/s41391-018-0114-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/17/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022]
Abstract
Background: Germline mutations in BRCA2 have been linked to a higher risk of prostate cancer (PCa), and high frequency of BRCA1 and BRCA2 (BRCA1/2) gene alterations was recently reported in metastatic castration-resistant PCa specimens. Mutations in BRCA2 vary in racial and ethnic groups including African-American (AA) and Caucasian-American (CA) populations. Methods: BRCA1 and BRCA2 genes were sequenced (Ion AmpliSeq targeted sequencing) in archived blood DNA specimens in 1240 PCa patients, including 30% AA patients, in three different cohorts: localized early stage (T2) PCa (N = 935); advanced PCa (50% T3–4) (N = 189); and metastatic PCa (N = 116). The sequences were analyzed for known and novel mutations in BRCA1/2. Statistical analyses were performed to determine associations of the mutations with clinico-pathological parameters. Results: BRCA2 mutations with known pathogenic annotation were significantly more prevalent in men with advanced and metastatic PCa (3.1%) compared to patients with an organ-confined disease (0.7%). AA patients carried more frequently BRCA1/2 variants of unknown significance (VUS) when compared to Caucasian Americans (4.6 vs. 1.6%, respectively). Significantly, pathogenic BRCA2 mutations in men with localized early stage PCa increased the risk of distant metastasis. Conclusions: Germline variants of unknown significance in BRCA1/2 are more frequent in AA than CA PCa patients; however, the prevalence of pathogenic mutations were similar across the races. Patients carrying BRCA2 pathogenic mutations are more likely to progress to metastasis.
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4
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Dinizo M, Shih W, Kwon YS, Eun D, Reese A, Giusto L, Trabulsi EJ, Yuh B, Ruel N, Marchalik D, Hwang J, Kundu SD, Eggener S, Kim IY. Multi-institution analysis of racial disparity among African-American men eligible for prostate cancer active surveillance. Oncotarget 2018; 9:21359-21365. [PMID: 29765545 PMCID: PMC5940363 DOI: 10.18632/oncotarget.25103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/21/2018] [Indexed: 12/27/2022] Open
Abstract
There is a significant controversy on whether race should be a factor in considering active surveillance for low-risk prostate cancer. To address this question, we analyzed a multi-institution database to assess racial disparity between African-American and White-American men with low risk prostate cancer who were eligible for active surveillance but underwent radical prostatectomy. A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes of men with low-risk prostate cancer from seven tertiary care institutions that underwent radical prostatectomy from 2003–2014 were used to assess potential racial disparity. Of the 333 (14.8%) African-American and 1923 (85.2%) White-American men meeting active surveillance criteria, African-American men were found to be slightly younger (57.5 vs 58.5 years old; p = 0.01) and have higher BMI (29.3 v 27.9; p < 0.01), pre-op PSA (5.2 v 4.7; p < 0.01), and maximum percentage cancer on biopsy (15.1% v 13.6%; p < 0.01) compared to White-American men. Univariate and multivariate analysis demonstrated similar rates of upgrading, upstaging, positive surgical margin, and biochemical recurrence between races. These results suggest that single institution studies recommending more stringent AS enrollment criteria for AA men with a low-risk prostate cancer may not capture the complete oncologic landscape due to institutional variability in cancer outcomes. Since all seven institutions demonstrated no significant racial disparity, current active surveillance eligibility should not be modified based upon race until a prospective study has been completed.
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Affiliation(s)
- Michael Dinizo
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Weichung Shih
- Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Young Suk Kwon
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Adam Reese
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Laura Giusto
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Edouard J Trabulsi
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bertram Yuh
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Nora Ruel
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Daniel Marchalik
- Department of Urology, Georgetown University, Washington, DC, USA
| | - Jonathan Hwang
- Department of Urology, Georgetown University, Washington, DC, USA
| | - Shilajit D Kundu
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Scott Eggener
- Section of Urology, University of Chicago, Chicago, IL, USA
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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5
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Filippou P, Ferguson JE, Nielsen ME. Epidemiology of Prostate and Testicular Cancer. Semin Intervent Radiol 2016; 33:182-5. [PMID: 27582605 DOI: 10.1055/s-0036-1586146] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prostate and testicular cancers account for a large percentage of cancer morbidity in men in the United States and worldwide due to high prevalence rates that continue to grow. Patterns of incidence and mortality vary greatly in both cancers among men of different age groups, ethnicities, and geographic locations. This article summarizes the incidence, prognosis, and risk factors of both prostate and testicular cancers, globally and in the United States.
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Affiliation(s)
- Pauline Filippou
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James E Ferguson
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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6
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Chaudhary AK, Bhat TA, Kumar S, Kumar A, Kumar R, Underwood W, Koochekpour S, Shourideh M, Yadav N, Dhar S, Chandra D. Mitochondrial dysfunction-mediated apoptosis resistance associates with defective heat shock protein response in African-American men with prostate cancer. Br J Cancer 2016; 114:1090-100. [PMID: 27115471 PMCID: PMC4865976 DOI: 10.1038/bjc.2016.88] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND African-American (AA) patients with prostate cancer (PCa) respond poorly to current therapy compared with Caucasian American (CA) PCa patients. Although underlying mechanisms are not defined, mitochondrial dysfunction is a key reason for this disparity. METHODS Cell death, cell cycle, and mitochondrial function/stress were analysed by flow cytometry or by Seahorse XF24 analyzer. Expression of cellular proteins was determined using immunoblotting and real-time PCR analyses. Cell survival/motility was evaluated by clonogenic, cell migration, and gelatin zymography assays. RESULTS Glycolytic pathway inhibitor dichloroacetate (DCA) inhibited cell proliferation in both AA PCa cells (AA cells) and CA PCa cells (CA cells). AA cells possess reduced endogenous reactive oxygen species, mitochondrial membrane potential (mtMP), and mitochondrial mass compared with CA cells. DCA upregulated mtMP in both cell types, whereas mitochondrial mass was significantly increased in CA cells. DCA enhanced taxol-induced cell death in CA cells while sensitising AA cells to doxorubicin. Reduced expression of heat shock proteins (HSPs) was observed in AA cells, whereas DCA induced expression of CHOP, C/EBP, HSP60, and HSP90 in CA cells. AA cells are more aggressive and metastatic than CA cells. CONCLUSIONS Restoration of mitochondrial function may provide new option for reducing PCa health disparity among American men.
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Affiliation(s)
- Ajay K Chaudhary
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Tariq A Bhat
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Sandeep Kumar
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Anil Kumar
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602, USA
| | - Rahul Kumar
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Shahriar Koochekpour
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.,Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Mojgan Shourideh
- Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Neelu Yadav
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Shanta Dhar
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602, USA
| | - Dhyan Chandra
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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7
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Faisal FA, Sundi D, Cooper JL, Humphreys EB, Partin AW, Han M, Ross AE, Schaeffer EM. Racial disparities in oncologic outcomes after radical prostatectomy: long-term follow-up. Urology 2015; 84:1434-41. [PMID: 25432835 DOI: 10.1016/j.urology.2014.08.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To report race-based outcomes after radical prostatectomy (RP) in a cohort stratified by National Comprehensive Cancer Network (NCCN) risk category with updated follow-up. MATERIALS AND METHODS Studies describing racial disparities in outcomes after RP are conflicting. We studied 15,993 white and 1634 African American (AA) pretreatment-naïve men who underwent RP at our institution (1992-2013) with complete preoperative and pathologic data. Pathologic outcomes were compared between races using appropriate statistical tests; biochemical recurrence (BCR) for men with complete follow-up was compared using multivariate models that controlled separately for preoperative and postoperative covariates. RESULTS Very low- and low-risk AA men were more likely to have positive surgical margins (P <.01), adverse pathologic features (P <.01), and be upgraded at RP (P <.01). With a median follow-up of 4.0 years after RP, AA race was an independent predictor of BCR among NCCN low-risk (HR, 2.16; P <.001) and intermediate-risk (hazard ratio [HR], 1.34; P = .024) classes and pathologic Gleason score ≤ 6 (HR, 2.42; P <.001) and Gleason score 7 (HR, 1.71; P <.001). BCR-free survival for very low-risk AA men was similar to low-risk white men (P = .890); BCR-free survival for low-risk AA men was similar to intermediate-risk white men (P = .060). CONCLUSION When stratified by NCCN risk, AA men with very low-, low-, or intermediate-risk prostate cancer who undergo RP are more likely to have adverse pathologic findings and BCR compared with white men. AA men with "low risk" prostate cancer, especially those considering active surveillance, should be counseled that their recurrence risks can resemble those of whites in higher risk categories.
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Affiliation(s)
- Farzana A Faisal
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
| | - Debasish Sundi
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - John L Cooper
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | | | - Alan W Partin
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Misop Han
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Ashley E Ross
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
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8
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Donin NM, Loeb S, Cooper PR, Roehl KA, Baumann NA, Catalona WJ, Helfand BT. Genetically adjusted prostate-specific antigen values may prevent delayed biopsies in African-American men. BJU Int 2014; 114:E50-E55. [PMID: 24712975 PMCID: PMC4326233 DOI: 10.1111/bju.12647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate whether genetic correction using the genetic variants prostate-specific antigen (PSA)-single nucleotide polymorphisms (SNPs) could reduce potentially unnecessary and/or delayed biopsies in African-American men. SUBJECTS AND METHODS We compared the genotypes of four PSA-SNPs between 964 Caucasian and 363 African-American men without known prostate cancer (PCa). We adjusted the PSA values based on an individual's PSA-SNP carrier status, and calculated the percentage of men that would meet commonly used PSA thresholds for biopsy (≥ 2.5 or ≥ 4.0 ng/mL) before and after genetic correction. Potentially unnecessary and delayed biopsies were defined as those men who were below and above the biopsy threshold after genetic correction, respectively. RESULTS Overall, 349 (96.1%) and 354 (97.5%) African-American men had measured PSA levels <2.5 and <4.0 ng/mL. Genetic correction in African-American men did not avoid any potentially unnecessary biopsies, but resulted in a significant (P < 0.001) reduction in potentially delayed biopsies by 2.5% and 3.9%, based on the biopsy threshold level. CONCLUSIONS There are significant differences in the influence of the PSA-SNPs between African-American and Caucasian men without known PCa, as genetic correction resulted in an increased proportion of African-American men crossing the threshold for biopsy. These results raise the question of whether genetic differences in PSA might contribute to delayed PCa diagnosis in African-American men.
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Affiliation(s)
- Nicholas M Donin
- Department of Urology, New York University Langone Medical Center and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Stacy Loeb
- Department of Urology, New York University Langone Medical Center and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Phillip R Cooper
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kimberly A Roehl
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nikola A Baumann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William J Catalona
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian T Helfand
- Division of Urology, NorthShore University Healthcare System, Evanston, IL, USA
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9
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Increased incidence of pathologically nonorgan confined prostate cancer in African-American men eligible for active surveillance. Urology 2013; 81:831-5. [PMID: 23465143 DOI: 10.1016/j.urology.2012.12.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/24/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the clinicopathologic findings of African-American (AA) and White-American (WA) men with prostate cancer (PCa) who were candidates for active surveillance (AS) and underwent radical prostatectomy (RP). METHODS Prospectively maintained database of men who underwent RP from 2 academic centers were analyzed retrospectively. Postoperative pathologic characteristics of patients who met the AS inclusion criteria of the University of California, San Francisco (UCSF) and National Comprehensive Cancer Network (NCCN) were evaluated. After RP, the rate of pathological upstaging and Gleason upgrading were compared between AA and WA men. RESULTS In the AA cohort, 196 and 124 men met the UCSF and NCCN criteria for AS, respectively. With respect to WA patients, 191 and 148 fulfilled the AS criteria for UCSF and NCCN, respectively. AA men had a higher percentage of maximum biopsy core than WA men (15.3%-20.4% vs 11.5%-15.0%, P <.05, respectively) in both cohorts. In addition, a greater proportion of AA men had multiple positive biopsy cores compared to WA men (45.2% vs 33.1%, P = .046) under the NCCN criteria. A higher proportion of AA men were upstaged (≥pT3) compared to WA men (19.4% vs 10.1%, P = .037). A multivariate regression test revealed that age, preoperative PSA, and number of positive cores were independent predictors of more advanced disease (upstaging and/or upgrading) in AA men. CONCLUSION AA men who were candidates for AS criteria had worse clinicopathological features on final surgical pathology than WA men. These results suggest that a more stringent AS criteria should be considered in AA men with prostate cancer.
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10
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Koscuiszka M, Hatcher D, Christos PJ, Rose AE, Greenwald HS, Chiu YL, Taneja SS, Mazumdar M, Lee P, Osman I. Impact of race on survival in patients with clinically nonmetastatic prostate cancer who deferred primary treatment. Cancer 2012; 118:3145-52. [PMID: 22020835 PMCID: PMC3623265 DOI: 10.1002/cncr.26619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/26/2011] [Accepted: 09/19/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate cancer (PCa) racial disparity studies typically focus on survival differences after curative treatment. The authors of this report hypothesized that comparing mortality rates between African American (AA) and Caucasian American (CA) patients who deferred primary treatment for clinically nonmetastatic PCa may provide a better assessment of the impact of race on the natural course of PCa. METHODS The pathology database of the New York Veterans Administration Medical Center (VAMC), an equal access-of-care facility, was searched for patients with biopsy-proven PCa. Inclusion criteria included 1) no evidence of metastatic disease or death within 3 years after diagnosis, 2) no primary treatment, and 3) a minimum of 5 years of follow-up for survivors. RESULTS In total, 518 patients met inclusion criteria between 1990 and 2005. AA patients were younger (P = .02) and had higher median prostate-specific antigen (PSA) levels (P = .001) at the time of diagnosis compared with CA patients. In a multivariate model, higher Gleason score and PSA level were associated with increased mortality (P = .001 and P = .03, respectively), but race was not a predictor of death from PCa. CONCLUSIONS The current data suggested that race did not have a major impact on survival in patients with PCa who deferred primary treatment for clinically nonmetastatic disease.
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Affiliation(s)
- Michael Koscuiszka
- Department of Urology, New York University School of Medicine, New York, New York
| | - David Hatcher
- Department of Urology, New York University School of Medicine, New York, New York
| | - Paul J. Christos
- Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, New York
| | - Amy E. Rose
- Department of Urology, New York University School of Medicine, New York, New York
| | | | - Ya-lin Chiu
- Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, New York
| | - Samir S. Taneja
- Department of Urology, New York University School of Medicine, New York, New York
| | - Madhu Mazumdar
- Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, New York
| | - Peng Lee
- Department of Urology, New York University School of Medicine, New York, New York
- Department of Pathology, New York University School of Medicine, New York, New York
- New York Harbor Healthcare System, New York, New York
| | - Iman Osman
- Department of Urology, New York University School of Medicine, New York, New York
- New York University Cancer Institute, New York, New York
- New York Harbor Healthcare System, New York, New York
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11
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Byun SS, Lee S, Lee SE, Lee E, Seo SI, Lee HM, Choi HY, Song C, Ahn H, Choi YD, Cho JS. Recent changes in the clinicopathologic features of Korean men with prostate cancer: a comparison with Western populations. Yonsei Med J 2012; 53:543-9. [PMID: 22476998 PMCID: PMC3343449 DOI: 10.3349/ymj.2012.53.3.543] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the recent changes in the clinicopathologic features of prostate cancer in Korea and to compare these features with those of Western populations. MATERIALS AND METHODS We retrospectively reviewed the data of 1582 men undergoing radical prostatectomy for clinically localized prostate cancer between 1995 and 2007 at 10 institutions in Korea for comparison with Western studies. The patients were divided into two groups in order to evaluate the recent clinicopathological changes in prostate cancer: Group 1 had surgery between 1995 and 2003 (n=280) and Group 2 had surgery between 2004 and 2007 (n=1302). The mean follow-up period was 24 months. RESULTS Group 1 had a higher prostate-specific antigen level than Group 2 (10.0 ng/mL vs. 7.5 ng/mL, respectively; p<0.001) and a lower proportion of biopsy Gleason scores ≤6 (35.0% vs. 48.1%, respectively; p<0.001). The proportion of patients with clinical T1 stage was higher in Group 2 than in Group 1. Group 1 had a lower proportion of organ-confined disease (59.6% vs. 68.6%; p<0.001) and a lower proportion of Gleason scores ≤6 (21.3% vs. 33.0%; p<0.001), compared to Group 2. However, the relatively higher proportion of pathologic Gleason scores ≤6 in Group 2 was still lower than those of Western men, even though the proportion of organ-confined disease reached to that of Western series. CONCLUSION Korean men with prostate cancer currently present better clinicopathologic parameters. However, in comparison, Korean men still show relatively worse pathologic Gleason scores than Western men.
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Affiliation(s)
- Seok-Soo Byun
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunsik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University School of Medicine, Chuncheon, Korea
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12
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Chu DI, Moreira DM, Gerber L, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Freedland SJ. Effect of race and socioeconomic status on surgical margins and biochemical outcomes in an equal-access health care setting: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Cancer 2012; 118:4999-5007. [PMID: 22415377 DOI: 10.1002/cncr.27456] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/17/2011] [Accepted: 12/13/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND The impact of race and socioeconomic status (SES) in prostate cancer (CaP) outcomes has been well-studied, but controversy remains. The associations of race/SES with intermediate CaP outcomes, including positive surgical margin (PSM) and biochemical recurrence (BCR), were explored in an equal-access setting. METHODS Data were retrospectively collected from 2502 men in the Shared Equal Access Regional Cancer Hospitals (SEARCH) database who underwent radical prostatectomy from 1989 to 2010. SES (income, education, employment, and poverty) was estimated from linkage of home ZIP code to census data. Logistic regression with adjustment for pre- and postoperative covariates estimated risk for associations between race/SES and pathologic outcomes. Cox proportional hazards models estimated risk for associations between race/SES and time to BCR. RESULTS Black men were more likely to have lower SES than white men (P < .001). On multivariate analysis, race was not associated with PSM, but higher SES was associated with less PSM and fewer Gleason sum ≥ 7 pathologic tumors when SES was assessed by education, employment, or poverty (P trend ≤ .051) and income, employment, or poverty (P trend ≤ 0.059), respectively. Crude Cox models showed black men had higher BCR risk (hazards ratio = 1.20, 95% confidence interval = 1.05-1.38, P = .009) that persisted after adjustment for covariates including SES (hazards ratio ≥ 1.18, P ≤ .040). Higher SES measured by income and poverty were associated with less BCR, but only for black men (P trend ≤ .048). CONCLUSIONS Even in an equal-access setting, higher SES predicted lower PSM risk, and race persisted in predicting BCR despite adjustment for SES. Low SES black patients may be at greatest risk for postprostatectomy BCR.
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Affiliation(s)
- David I Chu
- Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA
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13
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Chornokur G, Dalton K, Borysova M, Kumar N. Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer. Prostate 2011; 71:985-97. [PMID: 21541975 PMCID: PMC3083484 DOI: 10.1002/pros.21314] [Citation(s) in RCA: 255] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/02/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostate cancer (PCa) remains the most common malignancy and the second leading cause of cancer death among men in the United States. PCa exhibits the most striking racial disparity, as African American men are at 1.4 times higher risk of being diagnosed, and 2-3 times higher risk of dying of PCa, compared to Caucasian men. The etiology of the disparity has not been clearly elucidated. The objective of this article is to critically review the literature and summarize the most prominent PCa racial disparities accompanied by proposed explanations. METHODS The present literature on disparities at presentation, diagnosis, treatment, and survival of African American men affected by PCa was systematically reviewed. Original research as well as relevant review articles were included. RESULTS African American men persistently present with more advanced disease than Caucasian men, are administered different treatment regimens than Caucasian men, and have shorter progression-free survival following treatment. In addition, African American men report more treatment-related side-effects that translates to the diminished quality of life (QOL). CONCLUSIONS PCa racial disparity exists at stages of presentation, diagnosis, treatment regimens, and subsequent survival, and the QOL. The disparities are complex involving biological, socio-economic, and socio-cultural determinants. These mounting results highlight an urgent need for future clinical, scientific, and socio-cultural research involving transdisciplinary teams to elucidate the causes for PCa racial disparities.
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Affiliation(s)
- Ganna Chornokur
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
| | - Kyle Dalton
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
| | - Meghan Borysova
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
| | - Nagi Kumar
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL-33612, USA
- The Center for Equal Health, University of South Florida, Tampa, FL -33612, USA
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14
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Lee DJ, Ritch C, Desai M, Benson MC, McKiernan JM. The interaction of body mass index and race in predicting biochemical failure after radical prostatectomy. BJU Int 2011; 107:1741-7. [PMID: 20942835 PMCID: PMC6361109 DOI: 10.1111/j.1464-410x.2010.09768.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
STUDY TYPE Therapy (case series). LEVEL OF EVIDENCE 4 OBJECTIVE To examine the interaction of body mass index (BMI) and race in predicting biochemical failure (BCF) after radical prostatectomy (RP). The relative contribution of BMI and race to BCF after RP has not been well characterized. PATIENTS AND METHODS From 1988 to 2008, 969 white and black men underwent RP and BMI data were available. In all, 168 (17.3%) were black and 801 (82.7%) were white men. BCF was defined as a post-surgery PSA level≥0.2 ng/mL on ≥2 measurements. Cox regression methods were used to model the relationship between race, BMI and BCF. RESULTS The 969 men had a mean age of 59.8±7.2 years. There was no significant difference in BMI between black and white men (P=0.32). The 5-year disease-free survival for black obese men was the lowest at 48%, compared with non-obese black (73%), obese white (82%) and non-obese white men (83%, P<0.001). BMI did not have a significant impact on BCF. In a multivariate analysis, black race remained an independent predictor of BCF [hazard ratio (HR)=1.76, P=0.01]. BMI does not affect the risk of BCF in black men differently than white men (P value for interaction 0.93). CONCLUSIONS Black race is an independent predictor of biochemical failure after adjusting for pathological factors. The impact of BMI on BCF did not vary among different races. These findings suggest that elevated BMI does not affect the BCF rates of black men more than in other races, and that other factors may influence the racial variability in disease-free survival and BCF risk.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Columbia University Medical Center, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
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15
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Teeter AE, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Freedland SJ. Does PSADT after radical prostatectomy correlate with overall survival?--a report from the SEARCH database group. Urology 2010; 77:149-53. [PMID: 21145094 DOI: 10.1016/j.urology.2010.04.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/27/2010] [Accepted: 04/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine the correlation between the prostate-specific antigen doubling time (PSADT) and overall survival (OS) and among men in the SEARCH database (an older, racially diverse cohort undergoing RP at multiple Veterans Affairs medical centers). Previous studies largely performed at tertiary care centers with relatively young, racially homogenous cohorts found a short PSADT on recurrence after RP portended a poor prognosis. METHODS We performed a Cox proportional hazards analysis to examine the correlation between postrecurrence PSADT and the interval from recurrence to OS and prostate cancer-specific mortality among 345 men in the SEARCH database who had undergone RP from 1988 to 2008. We examined the PSADT as a categorical variable using the clinically significant cutpoints of <3, 3-8.9, 9-14.9, and ≥15 months. RESULTS A PSADT of <3 months (hazard ratio 5.48, P = .002) was associated with poorer OS than a PSADT of ≥15 months. A trend was seen toward worse OS for the men with a PSADT of 3-8.9 months (hazard ratio 1.70, P = .07). PSADTs of <3 months (P < .001) and 3-8.9 months (P = .004) were associated with an increased risk of prostate cancer-specific mortality. CONCLUSIONS In an older, racially diverse cohort, recurrence with a PSADT of <9 months was associated with worse all-cause mortality. The results of the present study have validated previous findings that PSADT is a useful tool for identifying men at increased risk of all-cause mortality early in their disease course.
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Affiliation(s)
- Anna E Teeter
- Division of Urologic Surgery and Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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16
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Jayachandran J, Bañez LL, Aronson WJ, Terris MK, Presti JC, Amling CL, Kane CJ, Freedland SJ. Obesity as a predictor of adverse outcome across black and white race: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database. Cancer 2009; 115:5263-71. [PMID: 19670453 DOI: 10.1002/cncr.24571] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Across multiple studies, obesity has been associated with an increased risk of higher grade disease and prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). Whether these associations vary by race is unknown. In the current study, the authors examined the association between obesity and outcome after RP stratified by race. METHODS A retrospective analysis was performed on 1415 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent RP between 1989 and 2008. The association between increased body mass index (BMI) and adverse pathology and biochemical recurrence was examined using multivariate logistic regression and Cox models, respectively. Data were examined stratified by race. RESULTS After adjusting for preoperative clinical characteristics, higher BMI was associated with higher tumor grade (P = .008) and positive surgical margins (P < .001) in white men, and similar but statistically nonsignificant trends were observed in black men. No significant interaction was noted between race and BMI for associations with adverse pathology (P(interaction)> or =.12). After adjusting for preoperative clinical characteristics, higher BMI was associated with an increased risk of recurrence in both white men (P = .001) and black men (P = .03). After further adjusting for pathologic variables, higher BMI was associated with significantly increased risk of recurrence in white men (P = .002) and black men (P = .01). No significant interactions were observed between race and BMI for predicting biochemical progression adjusting either for preoperative factors (P(interaction) = .35) or for preoperative and pathologic features (P(interaction) = .47). CONCLUSIONS Obesity was associated with a greater risk of recurrence among both black men and white men. Obesity did not appear to be more or less influential in 1 race than another but, rather, was identified as a risk factor for aggressive cancer regardless of race.
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Affiliation(s)
- Jayakrishnan Jayachandran
- Division of Urologic Surgery, Departments of Surgery and Pathology, and the Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA
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17
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Moreira DM, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, Sun LL, Moul JW, Freedland SJ. The effect of race on the discriminatory accuracy of models to predict biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases. Prostate Cancer Prostatic Dis 2009; 13:87-93. [PMID: 19918263 DOI: 10.1038/pcan.2009.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To evaluate whether race modifies the accuracy of nomograms to predict biochemical recurrence (BCR) after radical prostatectomy among subjects from the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. Retrospective analysis of 1721 and 4511 subjects from the SEARCH and DPC cohorts, respectively. The discrimination accuracy for BCR of seven previously published predictive models was assessed using concordance index and compared between African-American men (AAM) and Caucasian men (CM). AAM represented 44% of SEARCH and 14% of DPC. In both cohorts, AAM were more likely to experience BCR than CM (P<0.01). In SEARCH, the mean concordance index across all seven models was lower in AAM (0.678) than CM (0.715), though the mean difference between CM and AAM was modest (0.037; range 0.015-0.062). In DPC the overall mean concordance index for BCR across all seven nomograms was 0.686. In contrast to SEARCH, the mean concordance index in DPC was higher in AAM (0.717) than CM (0.681), though the mean differences between CM and AAM was modest (-0.036; range -0.078 to -0.004). Across all seven models for predicting BCR, the discriminatory accuracy was better among CM in SEARCH and better among AAM in DPC. The mean difference in discriminatory accuracy of all seven nomograms between AAM and CM was approximately 3-4%. This indicates that currently used predictive models have similar performances among CM and AAM. Therefore, nomograms represent a valid and accurate method to predict BCR regardless of race.
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Affiliation(s)
- D M Moreira
- Division of Urologic Surgery, Department of Surgery, and Duke Prostate Center, Duke University School of Medicine, Durham, NC, USA.
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18
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Tewari AK, Gold HT, Demers RY, Johnson CC, Yadav R, Wagner EH, Yood MU, Field TS, Divine G, Menon M. Effect of socioeconomic factors on long-term mortality in men with clinically localized prostate cancer. Urology 2009; 73:624-30. [PMID: 19167034 DOI: 10.1016/j.urology.2008.09.081] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 08/08/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine the effect of socioeconomic factors on survival in black and white patients with local or regional prostate cancer. METHODS All cases (n = 2046) of clinically localized prostate cancer diagnosed from 1990 to 2000 at the Henry Ford Health System and the Henry Ford Medical Group, equal access health centers, were included. Data on the stage, grade, age at diagnosis, socioeconomic status, treatment given, comorbidities, and vital statistics were gathered from the Henry Ford Medical Group tumor registry and computerized databases, pathologic reports, patient charts, Surveillance, Epidemiology, and End Results database, and the national death registry. The endpoints were the overall and cancer-specific survival. Survival was calculated using Cox proportional hazards regression models. RESULTS Of the 2046 cases, 1243 were white and 803 were black. Black patients were more likely to have lower incomes, a greater baseline prostate-specific antigen level, and greater comorbidities. They were also more likely to undergo radiotherapy and less likely to undergo radical prostatectomy. Univariate analysis, with white race as the baseline hazard, showed that black patients had significantly increased cancer-specific (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.01-2.13) and overall (HR 1.29, 95% CI 1.09-1.53) mortality. However, adjusting for insurance status and income on multivariate analysis revealed no significant differences in cancer-specific (HR 1.04, 95% CI 0.66-1.64) and overall (HR 0.96, 95% CI 0.78-1.18) survival. CONCLUSIONS In this cohort, socioeconomic factors were sufficient to explain the disparity in survival between white and black patients. Survival differences disappeared after adjusting for income status on multivariate analysis.
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Affiliation(s)
- Ashutosh K Tewari
- Department of Urology, Weill Medical College of Cornell University, New York, New York, USA.
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19
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Winterich JA, Quandt SA, Grzywacz JG, Clark PE, Miller DP, Acuña J, Arcury TA. Masculinity and the body: how African American and White men experience cancer screening exams involving the rectum. Am J Mens Health 2008; 3:300-9. [PMID: 19477742 DOI: 10.1177/1557988308321675] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Past research on prostate and colorectal cancer disparities finds that barriers to screening, such as embarrassment and offensiveness, are often reported. Yet none of this literature investigates why. This study uses masculinity and health theory to examine how men experience two common screenings: digital rectal exams (DREs) and colonoscopies. In-depth interviews were conducted with 64 African American and White men from diverse backgrounds, aged 40 to 64, from North Carolina. Regardless of race or education, men experienced DREs more negatively than colonoscopies because penetration with a finger was associated with a gay sexual act. Some men disliked colonoscopies, however, because they associated any penetration as an affront to their masculinity. Because beliefs did not differ by race, future research should focus on structural issues to examine why disparities persist with prostate and colorectal cancer. Recommendations are provided for educational programs and physicians to improve men's experiences with exams that involve the rectum.
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Affiliation(s)
- Julie A Winterich
- Department of Family & Community Medicine, Wake Forest University School of Medicine,Winston-Salem, North Carolina 27157-1084, USA.
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20
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Dash A, Lee P, Zhou Q, Jean-Gilles J, Taneja S, Satagopan J, Reuter V, Gerald W, Eastham J, Osman I. Impact of socioeconomic factors on prostate cancer outcomes in black patients treated with surgery. Urology 2008; 72:641-6. [PMID: 18295314 DOI: 10.1016/j.urology.2007.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 10/15/2007] [Accepted: 11/08/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The role of socioeconomic factors in the worse outcome of black men with prostate cancer remains unclear. To determine whether socioeconomic factors affect prostate cancer outcomes, we studied a cohort of only black patients to minimize known confounding factors. METHODS We studied black men treated with radical prostatectomy at New York Veterans Administration Medical Center and Memorial Sloan-Kettering Cancer Center between 1990 and 2005. A centralized pathology review process determined the Gleason score of all cases. Prostate-specific antigen (PSA) recurrence at both sites was defined as PSA of 0.2 or greater with a confirmatory rise. By matching patients' home zip codes to the U.S. Census Bureau database, we obtained corresponding socioeconomic data regarding median household income (income) and percentage of population with a high school (degree). We analyzed income, education, and clinical and pathological parameters for the whole cohort. RESULTS We studied 430 black patients. They resided in neighborhoods where median household income was $41,498.10 and mean percentage of high school graduates was 73.4%. A total of 88 patients (20.9%) had PSA recurrence. Median follow-up for survivors was 37 months. Neither income nor education evaluated as continuous or categorical variables were predictors of PSA recurrence. When evaluated as composite categorical variable, the combination of greater income and education did not predict disease-free survival. CONCLUSIONS Data suggest that socioeconomic factors have limited impact on PSA recurrence in black men treated with radical prostatectomy. Thus, biologic factors might have a role in the poor outcomes in this population.
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Affiliation(s)
- Atreya Dash
- Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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21
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Cooperberg MR, Broering JM, Latini DM, Litwin MS, Wallace KL, Carroll PR. Patterns of practice in the United States: insights from CaPSURE on prostate cancer management. Curr Urol Rep 2004; 5:166-72. [PMID: 15161564 DOI: 10.1007/s11934-004-0033-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10,000 patients with prostate cancer treated at 31 primarily community-based sites across the country. The database tracks oncologic and health-related quality-of-life outcomes. Because the urologists participating in the project treat according to their usual practices, CaPSURE facilitates the study of trends in disease-management strategies, offering a reflection of "real world" practice patterns. This review highlights key studies during the past several years that document downward risk migration, validates widely used prognostic nomograms, establishes prostate-specific antigen doubling time as a surrogate endpoint for disease-specific mortality, assesses the impact of treatment on patient-reported quality of life, and presents national trends in imaging test use and primary treatment strategies for localized disease.
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Affiliation(s)
- Matthew R Cooperberg
- University of California, San Francisco, Mount Zion Cancer Center, 1600 Divisadero Street, 6th Floor, San Francisco, CA 94115-1711, USA
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