Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Faculty of Life Sciences & Medicine, King's College London, London, UK.
Prostate Cancer Prostatic Dis. 2021 Jun;24(2):549-557. doi: 10.1038/s41391-020-00313-0. Epub 2021 Feb 8.
Experiences of African/Afro-Caribbean men on active surveillance (AS) for prostate cancer (PCa) in the United Kingdom (UK) are not well documented. We compared follow-up appointments, adherence, and clinical outcomes among African/Afro-Caribbean men on AS at a high-volume UK hospital with other ethnicities.
Men with confirmed low-intermediate risk Pca who attended the AS clinic (2005-2016) and had undergone ≥1 follow-up biopsy (n = 458) were included. Non-adherence (defined as >20% missed appointments), suspicion of disease progression (any upgrading, >30% positive cores, cT-stage > 3, PIRADS > 3), any upgrading from diagnostic biopsy and conversion to active treatment (prostatectomy, radiotherapy or hormone therapy) according to ethnicity (African/Afro-Caribbean versus other ethnicities) were assessed using multivariable regression analysis.
Twenty-three percent of eligible men were recorded as African/Afro-Caribbean, while the remainder were predominantly Caucasian. African/Afro-Caribbean men had slightly lower PSA at diagnosis (median 5.0 vs. 6.0 ng/mL) and more positive cores at diagnosis (median 2 vs. 1). They had a substantially higher rate of non-attendance at scheduled follow-up visits (24% vs. 10%, p < 0.001). Adjusted analyses suggest African/Afro-Caribbean men may be at increased risk of disease progression (hazard ratio [HR]: 1.38; 95% confidence interval [CI] 0.99-1.91, P = 0.054) and upgrading (HR: 1.29; 95% CI 0.87-1.92, P = 0.305), though neither reached statistical significance. No difference in risk of conversion to treatment was observed between ethnic groups (HR: 1.03; 95% CI 0.64-1.47, P = 0.873).
African/Afro-Caribbean men on AS for PCa in the UK are less likely to adhere to scheduled appointments, suggesting a more tailored service addressing their specific needs may be required. While African/Afro-Caribbean men were no more likely to convert to treatment than Caucasian/other men, findings of a potentially higher risk of disease progression signal the need for careful selection and monitoring of African/Afro-Caribbean men on AS. Larger prospective, multicentre studies with longer follow-up are required to provide more definitive conclusions.
在英国，针对非裔/非洲裔加勒比男性进行前列腺癌（PCa）主动监测（AS）的经验尚未得到充分记录。我们比较了在一家大容量英国医院接受 AS 治疗的非裔/非洲裔加勒比男性的随访预约、依从性和临床结局与其他种族之间的差异。
本研究纳入了 2005 年至 2016 年期间在 AS 诊所就诊并接受了至少 1 次随访活检的确诊为低中危 PCa 男性（n=458）。根据种族（非裔/非洲裔加勒比与其他种族），采用多变量回归分析评估非依从性（定义为超过 20%的预约缺勤）、疾病进展的怀疑（任何升级，>30%的阳性核心，cT 期>3，PIRADS>3）、任何诊断性活检升级和转为主动治疗（前列腺切除术、放疗或激素治疗）。
符合条件的男性中有 23%被记录为非裔/非洲裔加勒比人，而其余的主要是白种人。非裔/非洲裔加勒比男性的诊断时 PSA 略低（中位数 5.0 与 6.0ng/mL），诊断时阳性核心数更多（中位数 2 与 1）。他们在预约的随访就诊中未到场的比例明显较高（24%与 10%，p<0.001）。调整后的分析表明，非裔/非洲裔加勒比男性可能面临更高的疾病进展风险（风险比[HR]：1.38；95%置信区间[CI]：0.99-1.91，p=0.054）和升级风险（HR：1.29；95%CI：0.87-1.92，p=0.305），尽管均未达到统计学意义。两组之间在转为治疗的风险上没有差异（HR：1.03；95%CI：0.64-1.47，p=0.873）。
在英国，接受 PCa AS 治疗的非裔/非洲裔加勒比男性不太可能遵守预约，这表明可能需要针对他们的特定需求提供更具针对性的服务。虽然非裔/非洲裔加勒比男性转为治疗的可能性并不高于白种人/其他男性，但疾病进展风险可能更高的发现表明，需要仔细选择和监测接受 AS 的非裔/非洲裔加勒比男性。需要更大规模的前瞻性、多中心研究并进行更长时间的随访，以提供更明确的结论。
