Department of Urology, University of Miami, Miami, FL, USA.
Department of Radiation Oncology, University of Miami, Miami, FL, USA.
Prostate Cancer Prostatic Dis. 2018 Nov;21(4):533-538. doi: 10.1038/s41391-018-0057-6. Epub 2018 Jul 9.
Non-Hispanic Black (NHB) men are at an increased risk for aggressive prostate cancer (PCa), making active surveillance (AS) potentially less optimal in this population. This concern has not been explored in other minority populations-specifically, Hispanic/Latino men. We recently found that Mexican-American men demonstrate an increased risk of PCa-specific mortality, and we hypothesized that they may also be at risk for an adverse outcome on AS.
Using the Surveillance, Epidemiology, and End Results (SEER) program, we extracted a population-based cohort of men diagnosed from 2004 to 2013 with localized or regional PCa, who had ≤2 cores of only Grade Group (GG) 1 cancer, and underwent radical prostatectomy (RP) with available biopsy and surgical pathology results. We measured discovery of high-risk PCa at RP and collected socioeconomic status (SES) data across different racial/ethnic groups. We defined aggressive tumors as either an upgrade to GG 3 or higher (GG3+) cancer or non-organ-confined disease (≥pT3a or N1). Univariate and multivariate logistic regression models were developed to assess the association between racial/ethnic categories and the previously mentioned adverse oncologic outcomes both with and without adjusting for SES factors.
NHB and Mexican-American men were significantly more likely to have aggressive PCa, following RP. In multivariable logistic regression adjusting for SES factors and relative to non-Hispanic White (NHW) men, Mexican-American men had at increased odds of upgrading to GG3+ (OR 1.67; 95% CI [1.00-2.90]). NHB men were more likely to have non-organ-confined disease (OR 1.34; 95% CI [1.06-1.69]), while Mexican-American men had a similar risk to NHW men.
Among individuals with low-risk PCa and eligible for AS, Mexican-American and NHB men are at an increased risk of harboring more aggressive disease at RP. This novel finding among Mexican-Americans deserves further evaluation.
非西班牙裔黑人（NHB）男性患侵袭性前列腺癌（PCa）的风险增加，使得主动监测（AS）在该人群中不太理想。这一担忧尚未在其他少数族裔群体中得到探讨——特别是西班牙裔/拉丁裔男性。我们最近发现，墨西哥裔美国男性患前列腺癌特异性死亡的风险增加，我们假设他们在 AS 中也可能面临不良后果的风险。
我们利用监测、流行病学和最终结果（SEER）计划，提取了一组 2004 年至 2013 年间诊断为局限性或区域性 PCa 的男性人群，这些男性患者仅接受了≤2 次 GG1 级（GG1）癌症的核心活检，且接受了根治性前列腺切除术（RP），并可获得活检和手术病理结果。我们在 RP 时测量了高危 PCa 的发现情况，并在不同种族/族裔群体中收集了社会经济地位（SES）数据。我们将侵袭性肿瘤定义为 GG3 级或更高（GG3+）癌症或非器官受限疾病（≥pT3a 或 N1）。我们开发了单变量和多变量逻辑回归模型，以评估种族/族裔类别与之前提到的不良肿瘤学结局之间的关联，同时调整和不调整 SES 因素。
在 RP 后，NHB 和墨西哥裔美国男性更有可能患有侵袭性 PCa。在调整 SES 因素的多变量逻辑回归中，与非西班牙裔白人（NHW）男性相比，墨西哥裔美国男性 GG3+升级的可能性更高（OR 1.67；95%CI[1.00-2.90]）。NHB 男性更有可能患有非器官受限疾病（OR 1.34；95%CI[1.06-1.69]），而墨西哥裔美国男性与 NHW 男性的风险相似。
在患有低危 PCa 且符合 AS 条件的个体中，墨西哥裔美国人和 NHB 男性在 RP 时更有可能患有侵袭性更强的疾病。这一在墨西哥裔美国人中发现的新现象值得进一步评估。
