For African Americans With Low-Grade Prostate Cancer, Observation May Not Be Enough

A new study from Thomas Jefferson University suggests that observation may not be right for all patients with early stage prostate cancer.

“We know that African American men have more aggressive prostate cancer than Caucasian men,” Kosj Yamoah MD, PhD, Chief Resident, Department of Radiation Oncology at Thomas Jefferson University in Philadelphia, said in a statement. “Our study shows that African American men who are diagnosed with a low-grade cancer at first—the cancers that are sometimes watched rather than treated—are more likely to develop aggressive much sooner than Caucasian men.”

For this study, researchers looked at patients whose cancers were low to intermediate grade and who underwent surgery to remove all or part of their prostate.

Researchers only analyzed the records of men whose cancers were confirmed to be low grade after surgical removal via a so-called “pathologic” Gleason scoring system.

The researchers found that even in these confirmed low-grade cancers, African American men were more likely to have disease progression and worse outcomes than Caucasian men. There was about a 10% to 15% difference in 7-year disease control in this low-grade group (90% disease control at 7 years for Caucasian men vs 79% in African American men).

Yamoah and colleagues stress that these findings are based on retrospective analysis, which looks at patient records, and that a prospective analysis will be more definitive in helping determine whether African American men with a low Gleason score should receive more aggressive treatment.

Currently, Yamoah is investigating the molecular fingerprint that would help identify the African American men at highest risk for disease progression compared with those for whom watchful waiting could still be the best option.