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Substantial Gleason reclassification in Black men with national comprehensive cancer network low-risk prostate cancer – A propensity score analysis

Prostate Cancer and Prostatic Diseases volume 25, pages 547–552 (2022)Cite this article

Subjects

Abstract

Background

Emerging evidence suggests that a subset of Black men with National Comprehensive Cancer Network (NCCN) low-risk prostate cancer (PCa) may harbor high volume and genomically aggressive disease. However, limited, and ambiguous research exist to evaluate the risk of extreme Gleason reclassification in Black men with low-risk PCa.

Methods

This retrospective cohort study included 45,674 low-risk PCa patients who underwent prostatectomy and were not on active surveillance, from National Cancer Database (NCDB). A propensity score matched-pair design was employed, and the final cohort was limited to 1:1 matched 12,340 patients. Gleason score reclassification was used as primary endpoint. As such, any migration to pathologic Gleason score ≥7(3 + 4) was identified as overall, whereas migration to ≥7(4 + 3) was defined as extreme reclassification. A conditional Poisson regression model was used to estimate the risk of reclassification. Whereas spline model was used to estimate the impact of increasing time to treatment as a non-linear function on Gleason reclassification between race group.

Results

Upon matching there were no differences in the baseline characteristics between race groups. In a matched cohort, higher proportion of low-risk Black men (6.6%) reported extreme reclassification to pathologic Gleason score than White men (5.0%), p < 0.001. In a conditional Poisson regression model adjusted for time to treatment, the risk of overall (RR = 1.09, 95% CI, 1.05–1.13, p < 0.001) and extreme (RR = 1.30, 95% CI, 1.12–1.50, p = 0.004) reclassification was significantly higher in Black men as compared to their White counterpart. In spline model, the probability of Gleason reclassification in Black men was elevated with increasing time to treatment, especially after 180 days (53% vs. 43% between Black and White men).

Conclusion

Risk of Gleason score reclassification is disparately elevated in Black men with low-risk PCa. Furthermore, time to treatment can non-linearly impact Gleason reclassification in Black men.

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Fig. 1: Consort diagram for the NCCN low-risk cohort selection.
Fig. 2: Spline model to estimate Gleason reclassification with increasing time to treatment.

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References

  1. Wilt TJ, Jones KM, Barry MJ, Andriole GL, Culkin D, Wheeler T, et al. Follow-up of prostatectomy versus observation for early prostate cancer. N. Engl J Med. 2017;377:132–42.

    Article  Google Scholar 

  2. Nevedomskaya E, Baumgart SJ, Haendler B. Recent advances in prostate cancer treatment and drug discovery. Int. J. Mol. Sci. 2018;19:1359.

    Article  Google Scholar 

  3. Williams VL, Awasthi S, Fink AK, Pow-Sang JM, Park JY, Gerke T, et al. African-American men and prostate cancer-specific mortality: A competing risk analysis of a large institutional cohort, 1989-2015. Cancer Med. 2018;7:2160–71.

    Article  Google Scholar 

  4. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA: A Cancer J Clinicians. 2019;69:211–33.

    Google Scholar 

  5. Tsodikov A, Gulati R, de Carvalho TM, Heijnsdijk EAM, Hunter-Merrill RA, Mariotto AB, et al. Is prostate cancer different in black men? Answers from 3 natural history models. Cancer. 2017;123:2312–9.

    Article  Google Scholar 

  6. Powell IJ, Bock CH, Ruterbusch JJ, Sakr W. Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in black than in white American men, and influences racial progression and mortality disparity. J Urol. 2010;183:1792–6.

    Article  Google Scholar 

  7. Spratt DE, Zhang J, Santiago-Jiménez M, Dess RT, Davis JW, Den RB, et al. Development and validation of a novel integrated clinical-genomic risk group classification for localized prostate cancer. J Clin Oncol. 2018;36:581–90.

    Article  Google Scholar 

  8. Mahal BA, Alshalalfa M, Spratt DE, Davicioni E, Zhao SG, Feng FY, et al. Prostate cancer genomic-risk differences between african-american and white men across Gleason scores. Eur Urol. 2019;75:1038–40.

    Article  Google Scholar 

  9. Deka R, Parsons JK, Simpson DR, Riviere P, Nalawade V, Vitzthum LK, et al. African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: Implications for active surveillance. Prostate Cancer Prostatic Dis. 2020;23:581–8.

    Article  Google Scholar 

  10. Gökce MI, Sundi D, Schaeffer E, Pettaway C. Is active surveillance a suitable option for African American men with prostate cancer? A systemic literature review. Prostate Cancer Prostatic Dis. 2017;20:127–36.

    Article  Google Scholar 

  11. Butler S, Muralidhar V, Chavez J, Fullerton Z, Mahal A, Nezolosky M, et al. Active surveillance for low-risk prostate cancer in Black patients. N. Engl J Med. 2019;380:2070–2.

    Article  Google Scholar 

  12. Katz JE, Chinea FM, Patel VN, Balise RR, Venkatramani V, Gonzalgo ML, et al. Disparities in Hispanic/Latino and non-Hispanic Black men with low-risk prostate cancer and eligible for active surveillance: A population-based study. Prostate Cancer Prostatic Dis. 2018;21:533–8.

    Article  Google Scholar 

  13. Schenk JM, Newcomb LF, Zheng Y, Faino AV, Zhu K, Nyame YA, et al. African American race is not associated with risk of reclassification during active surveillance: Results from the Canary prostate cancer active surveillance study. J Urol. 2020;203:727–33.

    Article  Google Scholar 

  14. Mahal BA, Berman RA, Taplin ME, Huang FW. Prostate cancer-specific mortality across Gleason scores in black vs nonblack men. Jama. 2018;320:2479–81.

    Article  Google Scholar 

  15. Sundi D, Ross AE, Humphreys EB, Han M, Partin AW, Carter HB, et al. African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: Should active surveillance still be an option for them? J Clin Oncol. 2013;31:2991–7.

    Article  Google Scholar 

  16. Deka R, Courtney PT, Parsons JK, Nelson TJ, Nalawade V, Luterstein E, et al. Association between African American race and clinical outcomes in men treated for low-risk prostate cancer with active surveillance. JAMA. 2020;324:1747–54.

    Article  Google Scholar 

  17. Maurice MJ, Sundi D, Schaeffer EM, Abouassaly R. Risk of pathological upgrading and up staging among men with low risk prostate cancer varies by race: Results from the national cancer database. J Urol. 2017;197:627–31.

    Article  Google Scholar 

  18. Awasthi S, Gerke T, Park JY, Asamoah FA, Williams VL, Fink AK, et al. Optimizing time to treatment to achieve durable biochemical disease control after surgery in prostate cancer: A multi-institutional cohort study. Cancer Epidemiol Biomark Prev. 2019;28:570–7.

    Article  Google Scholar 

  19. Stokes WA, Hendrix LH, Royce TJ, Allen IM, Godley PA, Wang AZ, et al. Racial differences in time from prostate cancer diagnosis to treatment initiation: A population-based study. Cancer. 2013;119:2486–93.

    Article  Google Scholar 

  20. Boffa DJ, Rosen JE, Mallin K, Loomis A, Gay G, Palis B, et al. Using the National cancer database for outcomes research: A review. JAMA Oncol. 2017;3:1722–8.

    Article  Google Scholar 

  21. Flanagin A, Frey T, Christiansen SL. Updated guidance on the reporting of race and ethnicity in medical and science journals. Jama. 2021;326:621–7.

    Article  Google Scholar 

  22. Hall WH, Jani AB, Ryu JK, Narayan S, Vijayakumar S. The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer. Prostate Cancer Prostatic Dis. 2005;8:22–30.

    Article  CAS  Google Scholar 

  23. Sundi D, Kryvenko ON, Carter HB, Ross AE, Epstein JI, Schaeffer EM. Pathological examination of radical prostatectomy specimens in men with very low risk disease at biopsy reveals distinct zonal distribution of cancer in black American men. J Urol. 2014;191:60–7.

    Article  Google Scholar 

  24. Mygatt JG, Cullen J, Streicher SA, Kuo HC, Chen Y, Young D, et al. Race, tumor location, and disease progression among low-risk prostate cancer patients. Cancer Med. 2020;9:2235–42.

    Article  CAS  Google Scholar 

  25. Hoge C, Verma S, Lama DJ, Bergelson I, Haj-Hamed M, Maynor S, et al. Racial disparity in the utilization of multiparametric MRI–ultrasound fusion biopsy for the detection of prostate cancer. Prostate Cancer Prostatic Dis. 2020;23:567–72.

    Article  Google Scholar 

  26. Dinh KT, Mahal BA, Ziehr DR, Muralidhar V, Chen YW, Viswanathan VB, et al. Incidence and predictors of upgrading and up staging among 10,000 contemporary patients with low risk prostate cancer. J Urol. 2015;194:343–9.

    Article  Google Scholar 

  27. Singh RV, Agashe SR, Gosavi AV, Sulhyan KR. Interobserver reproducibility of Gleason grading of prostatic adenocarcinoma among general pathologists. Indian J Cancer. 2011;48:488–95.

    Article  CAS  Google Scholar 

  28. Allsbrook WC Jr, Mangold KA, Johnson MH, Lane RB, Lane CG, Epstein JI. Interobserver reproducibility of Gleason grading of prostatic carcinoma: general pathologist. Hum Pathol. 2001;32:81–8.

    Article  Google Scholar 

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Funding

This research was supported by the American Cancer Society MRSG‐17‐108‐01‐TBG (to KY), and P20‐CA233255 (to KY and TRR).

Author information

Authors and Affiliations

  1. Department of Cancer Epidemiology, H Lee Moffitt Cancer Center, Tampa, FL, USA

    Shivanshu Awasthi, Jong Y. Park & Asmaa Elkenawi

  2. University of Miami Miller School of Medicine (MSOM)-Sylvester Comprehensive Cancer Center (SCCC), Miami, FL, USA

    Brandon A. Mahal

  3. Department of Health Informatics, H Lee Moffitt Cancer Center, Tampa, FL, USA

    Jordan H. Creed

  4. Collaborative Data Services Core, H Lee Moffitt Cancer Center, Tampa, FL, USA

    Vonetta L. Williams

  5. The City University of New York, CUNY, New York, NY, USA

    Sylvester O. Meadows

  6. Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA

    Julio M. Pow-Sang

  7. Thomas Jefferson University and Sidney Kimmel Cancer Center, Philadelphia, PA, USA

    Grace Lu-Yao & Wm. Kevin Kelly

  8. CUNY Academy for the Humanities and Sciences, New York, NY, USA

    Damaris-Lois Y. Lang

  9. College of Public Health University of South Florida, Tampa, FL, USA

    Janice Zgibor

  10. Harvard T.H Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, USA

    Timothy R. Rebbeck

  11. Department Cancer Epidemiology and Radiation Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA

    Kosj Yamoah

Authors
  1. Shivanshu Awasthi
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  2. Brandon A. Mahal
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  9. Grace Lu-Yao
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  14. Kosj Yamoah
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Contributions

Concept and study design—SA; KY. Data acquisition—VLW SA, KY, Analysis and Interpretation of data—SA, KY, JHC, and TRR. Original draft—SA, KY. Critical revision of paper BM, JYP, JHC, VLW, AE, SOM, JMP, GLY, WKK, DYL, JZ, TRR, and KY. Statistical analysis—SA, JHC. Supervision—JZ, TRR, and KY.

Corresponding author

Correspondence to Kosj Yamoah.

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Awasthi, S., Mahal, B.A., Park, J.Y. et al. Substantial Gleason reclassification in Black men with national comprehensive cancer network low-risk prostate cancer – A propensity score analysis. Prostate Cancer Prostatic Dis 25, 547–552 (2022). https://doi.org/10.1038/s41391-022-00510-z

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