African American Men With Low-Risk Prostate Cancer Are Candidates for Active Surveillance: The Will-Rogers Effect?

It is controversial whether African American men(AAM) with low-risk prostate cancer (PC) should be placed on active surveillance (AS). Recent literature indicates AAM diagnosed with low-risk disease have increased pathologic upgrading and disease progression. We evaluated the surgical pathology of AAM and Caucasians who underwent prostatectomy to assess the suitability of AAM for AS. We retrospectively reviewed 1,034 consecutive men who underwent open prostatectomy between 2004 and 2015; 345 Caucasians and 58 AAM met the American Urological Association criteria for low-risk PC. We excluded from analysis two men whose prostatectomies were aborted. Chi-square test, Fisher's exact test, and Wilcoxon rank sum test were used for statistical analysis. AAM with low-risk PC have a lower rate of surgical upgrading and similar rates of adverse pathology compared with Caucasians. 29.8% of AAM (17/57) diagnosed with low-risk disease but 44.5% of Caucasians (153/344) had disease upgrading at prostatectomy ( p < .04), although AAM overall were less likely to be clinically diagnosed with low-risk cancer (33.1 vs. 41.7%, p < .05). AAM with low-risk pathology were younger (median 55 vs. 59 years, p < .001) and had smaller prostates (32 vs. 35 g, p < .04). AAM with preoperative low-risk disease have lower rates of surgical upgrading and similar adverse pathology compared with Caucasians. There may be a Will-Rogers effect as AAM with aggressive disease appear more likely to be stratified into intermediate- and high-risk groups, leaving those AAM diagnosed with low-risk disease fully eligible for AS. Our results support that AS for AAM should remain a viable option.