Fewer Black Men Adopt Active Surveillance for Prostate Cancer
FRIDAY, June 7, 2019 -- Overall rates of active surveillance are up for all men with low-risk prostate cancer, although the increase is significantly smaller for black men, according to a research letter published in the May 23 issue of the New England Journal of Medicine.
Santino Butler, from the Dana-Farber Cancer Institute in Boston, and colleagues used the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting Database (2010 to 2015) to identify patients with low-risk prostate cancer (defined as clinical stage T1 to T2, a Gleason score of ≤6, and a prostate-specific antigen level of <10 ng/mL). Management type was known for all 50,302 patients (14.9 percent black).
The researchers found that from 2010 through 2015, the use of radical prostatectomy and definitive radiotherapy decreased among black men, from 41.4 and 46.0 percent, respectively, to 28.8 and 34.8 percent, respectively. Among nonblack men, the corresponding decreases were from 48.5 and 36.7 percent, respectively, to 31.8 and 24.9 percent, respectively (P < 0.001 for trend). During the same period, the use of active surveillance increased from 12.6 to 36.4 percent among black men and from 14.8 to 43.3 percent among nonblack men (P < 0.001 for trend). When adjusting for socioeconomic status and insurance status, race was not significantly associated with receipt of active surveillance (adjusted odds ratio [aOR] among black men, 1.01; 95 percent confidence interval [CI], 0.95 to 1.07; P = 0.86). However, the odds for receipt of active surveillance in adjusted analysis shifted during the study period (among black men versus nonblack men in 2010: aOR, 1.06; 95 percent CI, 0.89 to 1.25; P = 0.52; among black men versus nonblack men in 2015: aOR, 0.84; 95 percent CI, 0.73 to 0.98; P = 0.02 [P = 0.02 for trend]).
"Black men were less likely than nonblack men to receive active surveillance or watchful waiting by 2015, even after adjustment for socioeconomic status -- a finding that suggests a possible lower relative uptake of active surveillance or watchful waiting over time for black men," the authors write.
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Posted: June 2019