As I recall, African-American men are at the highest risk of prostate cancer in the world. Are African-American men with very low risk prostate cancer more likely (as compared to their white American counterparts) to have more aggressive disease that goes undetected with current diagnostic approaches? The answer appears to be yes, at least according to a retrospective analysis conducted at Johns Hopkins University in Baltimore (USA).
Results: African-American men had significantly higher rates of upgrading at surgery (compared to whites): 27% versus 14%, and more aggressive pathology (high-risk disease): 14% versus 8%.
My take: This is the largest cohort to date of black men who qualify for active surveillance. While active surveillance is an effective management strategy for many, men thought to be at low risk aren’t necessarily so. The authors feel that race-specific criteria for entry into active surveillance are needed. For every 100 African-American men with a very low risk profile in the study, 25 had higher-risk disease. For every 100 such white men, 15 had higher risk disease. I’m Dr. Michael Hunter.
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Reference: Journal of Clinical Oncology, online edition (17 June 2013).