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Epstein M, Syed K, Danella J, Ginzburg S, Belkoff L, Tomaszewski J, Trabulsi E, Singer EA, Jacobs BL, Raman JD, Guzzo TJ, Uzzo R, Reese AC. Model risk scores may underestimate rate of biochemical recurrence in African American men with localized prostate cancer: a cohort analysis of over 3000 men. Prostate Cancer Prostatic Dis 2024; 27:257-263. [PMID: 37821578 DOI: 10.1038/s41391-023-00727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/09/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This study aims to determine if there is a difference in prostate cancer nomogram-adjusted risk of biochemical recurrence (BCR) and/or adverse pathology (AP) between African American (AAM) and Caucasian men (CM) undergoing radical prostatectomy (RP). METHODS A retrospective review was performed of men undergoing RP in the Pennsylvania Urologic Regional Collaborative between 2015 and 2021. Cox proportional hazard regression models were used to compare the rate of BCR after RP, and logistic regression models were used to compare rates of AP after RP between CM and AAM, adjusting for the CAPRA, CAPRA-S, and MSKCC pre- and post-operative nomogram scores. RESULTS Rates of BCR and AP after RP were analyzed from 3190 and 5029 men meeting inclusion criteria, respectively. The 2-year BCR-free survival was lower in AAM (72.5%) compared to CM (79.0%), with a hazard ratio (HR) of 1.38 (95% CI 1.16-1.63, p < 0.001). The rate of BCR was significantly greater in AAM compared to CM after adjustment for MSKCC pre-op (HR 1.29; 95% CI 1.08-1.53; p = 0.004), and post-op nomograms (HR 1.26; 95% CI 1.05-1.49; p < 0.001). There was a trend toward higher BCR rates among AAM after adjustment for CAPRA (HR 1.13; 95% CI 0.95-1.35; p = 0.17) and CAPRA-S nomograms (HR 1.11; 95% 0.93-1.32; p = 0.25), which did not reach statistical significance. The rate of AP was significantly greater in AAM compared to CM after adjusting for CAPRA (OR 1.28; 95% CI 1.10-1.50; p = 0.001) and MSKCC nomograms (OR 1.23; 95% CI 1.06-1.43; p = 0.007). CONCLUSION This analysis of a large multicenter cohort provides further evidence that AAM may have higher rates of BCR and AP after RP than is predicted by CAPRA and MSKCC nomograms. Accordingly, AAM may benefit with closer post-operative surveillance and may be more likely to require salvage therapies.
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Affiliation(s)
- Matthew Epstein
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Kaynaat Syed
- Health Care Improvement Foundation, Philadelphia, PA, USA
| | | | | | | | | | | | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Jay D Raman
- Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Robert Uzzo
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Adam C Reese
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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Lian B, Qu M, Zhang W, Dong Z, Chen H, Jia Z, Wang Y, Li J, Gao X. Establishment and Validation of a Novel Prediction Model for Early Natural Biochemical Recurrence After Radical Prostatectomy Based on Post-Operative PSA at Sixth Week. Cancer Manag Res 2023; 15:377-385. [PMID: 37113984 PMCID: PMC10126833 DOI: 10.2147/cmar.s402241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Objective Based on post-operative PSA at 6th week (PSA6w) after radical prostatectomy to establish an optimal model for predicting natural biochemical recurrence (BCR). Methods A total of 742 patients with post-operative PSA6w from PC-follow database, between January 2003 and October 2022, were included. All the patients had not received any hormone therapy and radiotherapy before operation and BCR. Of these patients, 588 cases operated by one surgeon were enrolled for modelling and another 154 cases operated by other surgeons were for external validation. After screened by Cox regression, the post-operative PSA6w, pathological stage, Gleason Grade and positive surgical margins were adopted for modelling. The R software was used to plot the nomogram of the prediction model for BCR. C-index and calibration curve were calculated to evaluate the new model. Finally, integrated discrimination improvement was adopted to evaluate the prediction performances of the new nomogram model and the classical Kattan nomogram. Results The C-index of the new model was 0.871 (95% CI: 0.830-0.912). The calibration curve of the new model demonstrated superior consistency between the predicted and actual value. The C-index of the external validation group was 0.850 (95% CI: 0.742-0.958), which demonstrated perfect universality. The integrated discrimination improvement showed a 12.61% improvement in prediction performance over that of the classical Kattan nomogram (P < 0.01). Based on the new nomogram, patients were divided to high and low BCR group with a 3 year BCR-free cutoff probability as 74.72%. Low-risk patients, accounting for 77.89% of the patients, have no need to follow up frequently with a false-negative rate only 5.24%, which will save medical resources to a large extent. Conclusion Post-operative PSA6w is a sensitive risk biomarker for early natural BCR. The new nomogram model could predict BCR probability with a higher accuracy and will further simplify the clinical follow-up strategies.
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Affiliation(s)
- Bijun Lian
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
- Department of Urology, the 903rd PLA Hospital, Hangzhou Medical College, Hangzhou, People’s Republic of China
| | - Min Qu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Wenhui Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Zhenyang Dong
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Huan Chen
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Zepeng Jia
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Jing Li
- Centre for Translational Medicine, Naval Medical University, Shanghai, People’s Republic of China
- Jing Li, Center for Translational Medicine, Navy Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, 200438, People’s Republic of China, Tel +86 21-31161718, Email
| | - Xu Gao
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
- Correspondence: Xu Gao, Department of Urology, Changhai Hospital, NO. 168 Changhai Road, Yangpu District, Shanghai, 200438, People’s Republic of China, Tel +86 21-31161717, Email
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Koller CR, Greenberg JW, Shelton TM, Hughes WM, Sanekommu G, Silberstein J, Krane LS. Prostate Cancer Lesions by Zone and Race: Does Multiparametric MRI Demonstrate Racial Difference in Prostate Cancer Lesions for African American Men? ACTA ACUST UNITED AC 2021; 28:2308-2316. [PMID: 34206419 PMCID: PMC8293119 DOI: 10.3390/curroncol28040212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
African American (AA) men have increased risk of prostate cancer diagnosis and mortality, but the cause remains unknown. MRI fusion improves diagnosis of localized prostate cancer, particularly in anterior lesions; however, cost and access are limited in a community practice setting. By utilizing a diverse cohort of veterans with equal access to care in a single payer system, we describe prostate cancer detection. We queried a prospectively maintained institutional review board-approved database of men undergoing prostate biopsy for untreated prostate cancer. We included all consecutive patients from October 2017 to February 2020. Statistical analysis including Kaplan–Meier Curves, Fisher’s exact test, and Forest plot was performed. From 246 consecutive patients, 166 were AA and 80 were non-AA. There were similar distributions of PSA, PSAD, and number of targetable lesions between the AA and non-AA cohort (p > 0.05 for all). We found no difference in location on MRI between race groups. There was similar cancer detection, focusing on anterior lesions and rate of positive Gleason grade (≥GG1) and clinically significant (≥GG2) cancer between cohorts. In a predominant AA cohort of veterans, we found similar distribution of location for MRI-targeted lesions, along with rates of tumor detection and aggressiveness of disease. In this single payer veteran population, we did not identify specific biologic differences inherent to tumor detection between AA and non-AA patients.
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Affiliation(s)
- Christopher R. Koller
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (C.R.K.); (J.W.G.); (T.M.S.); (W.M.H.); (G.S.)
| | - Jacob W. Greenberg
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (C.R.K.); (J.W.G.); (T.M.S.); (W.M.H.); (G.S.)
| | - Thomas M. Shelton
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (C.R.K.); (J.W.G.); (T.M.S.); (W.M.H.); (G.S.)
| | - William M. Hughes
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (C.R.K.); (J.W.G.); (T.M.S.); (W.M.H.); (G.S.)
| | - Ganesh Sanekommu
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (C.R.K.); (J.W.G.); (T.M.S.); (W.M.H.); (G.S.)
| | - Jonathan Silberstein
- Department of Genitourinary Oncology, Memorial Health System, Aventura, FL 33180, USA;
| | - Louis S. Krane
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (C.R.K.); (J.W.G.); (T.M.S.); (W.M.H.); (G.S.)
- Department of Urology, Southeastern Louisiana Veterans Health Care System, New Orleans, LA 70112, USA
- Correspondence: ; Tel.: +1-504-988-2750; Fax: +1-504-988-5059
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Campbell JM, Raymond E, O'Callaghan ME, Vincent AD, Beckmann KR, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti KL. Optimum Tools for Predicting Clinical Outcomes in Prostate Cancer Patients Undergoing Radical Prostatectomy: A Systematic Review of Prognostic Accuracy and Validity. Clin Genitourin Cancer 2017; 15:e827-e834. [DOI: 10.1016/j.clgc.2017.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/25/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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Bjartell A, Bottai M, Persson J, Bratt O, Damber JE, Stattin P, Akre O. Prediction of clinical progression after radical prostatectomy in a nationwide population-based cohort. Scand J Urol 2016; 50:255-9. [DOI: 10.1080/21681805.2016.1183226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Josefin Persson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Bratt
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Sweden
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Jan-Erik Damber
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Olof Akre
- Department of Medicine Solna, Karolinska Institutet, and Department of Urology, Karolinska University Hospital, Stockholm, Sweden
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Oh JJ, Park S, Lee SE, Hong SK, Lee S, Lee HM, Lee JK, Ho JN, Yoon S, Byun SS. Genome-wide detection of allelic genetic variation to predict biochemical recurrence after radical prostatectomy among prostate cancer patients using an exome SNP chip. J Cancer Res Clin Oncol 2015; 141:1493-501. [PMID: 25764380 DOI: 10.1007/s00432-015-1947-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/22/2015] [Indexed: 01/01/2023]
Abstract
PURPOSES Genetic variations among prostate cancer patients who underwent radical prostatectomies were evaluated to predict biochemical recurrence, and used to develop a clinical-genetic model that combines data on clinicopathological factors of prostate cancer and individual genetic variations. MATERIALS AND METHODS We genotyped 242,186 SNPs on a custom HumanExome BeadChip v1.0 (Illuminam Inc.) from the blood DNA of 776 PCa patients who underwent radical prostatectomy. Genetic data were analyzed to calculate an odds ratio as an estimate of the relative risk of biochemical recurrence. And we compared accuracies from the multivariate model incorporating clinicopathological factors between included and excluded selected lead single nucleotide polymorphisms. Biochemical recurrence-free survival outcomes also analyzed using these genetic variations. RESULTS Genetic array analysis indicated that eight single nucleotide polymorphisms (rs77080351, rs200944490, rs2071292, rs117237810, rs191118242, rs4965121, rs61742396, and rs6573513) were significant to predict biochemical recurrence after radical prostatectomy. When a multivariate model incorporating clinicopathological factors was devised to predict biochemical recurrence, the predictive accuracy of model was 85.1 %. By adding in two individual variations of single nucleotide polymorphisms in the multivariate model, the predictive accuracy increased to 87.7 % (P = 0.045). With three variations of single nucleotide polymorphisms, the predictive accuracy further improved to 89.0 % (P = 0.025). These genetic variations had a significantly decreased biochemical recurrence-free survival rate. CONCLUSIONS Based on exome array, the selected single nucleotide polymorphisms were predictors for biochemical recurrence. The addition of individualized genetic information effectively enhanced the predictive accuracy of biochemical recurrence among prostate cancer patients who underwent radical prostatectomy.
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Affiliation(s)
- Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam-Si, Kyunggi-do, 463-707, Korea
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Yamoah K, Walker A, Spangler E, Zeigler-Johnson CM, Malkowicz B, Lee DI, Dicker AP, Rebbeck TR, Lal P. African-american race is a predictor of seminal vesicle invasion after radical prostatectomy. Clin Genitourin Cancer 2014; 13:e65-72. [PMID: 25450037 DOI: 10.1016/j.clgc.2014.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The purpose of the study was to determine whether racial differences exist in the pattern of local disease progression among men treated with radical prostatectomy (RP) for localized prostate cancer (PCa), which is currently unknown. In this study we evaluated the pattern of adverse pathologic features in an identical cohort of African-American (AA) and Caucasian (CS) men with PCa. PATIENTS AND METHODS The overall cohort consisted of 1104 men (224 AA, and 880 CS) who underwent RP between 1990 and 2012. We compared preoperative factors and pathologic outcomes after RP across race groups. Multivariate analysis was used to identify factors predictive of adverse pathologic outcomes. The effect of race on adverse pathologic outcomes and biochemical control rate (BCR) was evaluated using multivariate regression model and Kaplan-Meier analysis. RESULTS The 10-year BCR was 59% versus 82% in AA and CS men, respectively (P = .003). There was no significant difference in extraprostatic spread (P = .14), positive surgical margin (P = .81), lymph node involvement (P = .71), or adverse pathologic features (P = .16) across race groups. However, among patients with ≥ 1 adverse pathologic features, AA men had higher rate of seminal vesicle invasion (SVI) compared with CS men (51% vs. 30%; P = .01). After adjusting for known predictors of adverse pathologic features AA race remained a predictor of SVI. CONCLUSION AA men have an increased risk of SVI after RP, particularly among men with Gleason ≤ 6 disease. This might represent racial differences in the biology of PCa disease progression, which contribute to poorer outcomes in AA men.
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Affiliation(s)
- Kosj Yamoah
- Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Amy Walker
- The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Elaine Spangler
- The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Charnita M Zeigler-Johnson
- Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bruce Malkowicz
- The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - David I Lee
- The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Adam P Dicker
- Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Timothy R Rebbeck
- The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Priti Lal
- The Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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African American men with low-grade prostate cancer have increased disease recurrence after prostatectomy compared with Caucasian men. Urol Oncol 2014; 33:70.e15-22. [PMID: 25304288 DOI: 10.1016/j.urolonc.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/19/2014] [Accepted: 07/15/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore whether disparities in outcomes exist between African American (AA) and Caucasian (CS) men with low-grade prostate cancer and similar cancer of the prostate risk assessment-postsurgery (CAPRA-S) features following prostatectomy (RP). METHODS The overall cohort consisted of 1,265 men (234 AA and 1,031 CS) who met the National comprehensive cancer network criteria for low- to intermediate-risk prostate cancer and underwent RP between 1990 and 2012. We first evaluated whether clinical factors were associated with adverse pathologic outcomes and freedom from biochemical failure (FFbF) using the entire cohort. Next, we studied a subset of 705 men (112 AA and 593 CS) who had pathologic Gleason score≤6 (low-grade disease). Using this cohort, we determined whether race affected FFbF in men with RP-proven low-grade disease and similar CAPRA-S scores. RESULTS With a median follow-up time of 27 months, the overall 7-year FFbF rate was 86% vs. 79% in CS and AA men, respectively (P = 0.035). There was no significant difference in one or more adverse pathologic features between CS vs. AA men (27% vs. 31%; P = 0.35) or CAPRA-S score (P = 0.28). In the subset analysis of patients with low-grade disease, AA race was associated with worse FFbF outcomes (P = 0.002). Furthermore, AA race was a significant predictor of FFbF in men with low-grade disease (hazard ratio = 2.01, 95% CI: 1.08-3.72; P = 0.029). CONCLUSIONS AA race is a predictor of worse FFbF outcomes in men with low-grade disease after RP. These results suggest that a subset of AA men with low-grade disease may benefit from more aggressive treatment.
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Sundi D, Ross AE, Humphreys EB, Han M, Partin AW, Carter HB, Schaeffer EM. 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. [PMID: 23775960 DOI: 10.1200/jco.2012.47.0302] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Active surveillance (AS) is a treatment option for men with very low-risk prostate cancer (PCa); however, favorable outcomes achieved for men in AS are based on cohorts that under-represent African American (AA) men. To explore whether race-based health disparities exist among men with very low-risk PCa, we evaluated oncologic outcomes of AA men with very low-risk PCa who were candidates for AS but elected to undergo radical prostatectomy (RP). PATIENTS AND METHODS We studied 1,801 men (256 AA, 1,473 white men, and 72 others) who met National Comprehensive Cancer Network criteria for very low-risk PCa and underwent RP. Presenting characteristics, pathologic data, and cancer recurrence were compared among the groups. Multivariable modeling was performed to assess the association of race with upgrading and adverse pathologic features. RESULTS AA men with very low-risk PCa had more adverse pathologic features at RP and poorer oncologic outcomes. AA men were more likely to experience disease upgrading at prostatectomy (27.3% v 14.4%; P < .001), positive surgical margins (9.8% v 5.9%; P = .02), and higher Cancer of the Prostate Risk Assessment Post-Surgical scoring system (CAPRA-S) scores. On multivariable analysis, AA race was an independent predictor of adverse pathologic features (odds ratio, [OR], 3.23; P = .03) and pathologic upgrading (OR, 2.26; P = .03). CONCLUSION AA men with very low-risk PCa who meet criteria for AS but undergo immediate surgery experience significantly higher rates of upgrading and adverse pathology than do white men and men of other races. AA men with very low-risk PCa should be counseled about increased oncologic risk when deciding among their disease management options.
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Ho T, Gerber L, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy: biology or technique? Results from the SEARCH database. Eur Urol 2012; 62:910-6. [PMID: 22921964 DOI: 10.1016/j.eururo.2012.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 08/12/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. OBJECTIVE To examine whether obesity predicts higher prostate-specific antigen (PSA) nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration-based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. INTERVENTION All patients underwent RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA nadir. RESULTS AND LIMITATIONS Mean BMI was 28.5 kg/m2. Higher BMI was associated with higher PSA nadir on both univariable (p=0.001) and multivariable analyses (p<0.001). Increased BMI was associated with increased BCR risk (hazard ratio [HR]: 1.06; p=0.007). Adjusting for PSA nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p=0.043). When stratified by PSA nadir, obesity only significantly predicted BCR in men with an undetectable nadir (p=0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. CONCLUSIONS Obese men are more likely to have a higher PSA nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.
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Affiliation(s)
- Tammy Ho
- Divison of Urologic Surgery, Department of Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA
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Yamoah K, Stone N, Stock R. Impact of race on biochemical disease recurrence after prostate brachytherapy. Cancer 2011; 117:5589-600. [PMID: 21692058 DOI: 10.1002/cncr.26183] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/15/2011] [Accepted: 03/16/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Understanding racial differences in disease presentation and response to therapy is necessary for the effective treatment and control of prostate cancer. In this study, the authors examined the influence of race on biochemical disease-free survival (BDFS) among men who received prostate brachytherapy. METHODS In total, 2301 men were identified who had a minimum follow-up of 24 months and had received low-dose-rate brachytherapy for prostate cancer at the Mount Sinai Medical Center from June 1990 to October 2008. Patient factors, with specific emphasis on patient race, were analyzed with respect to freedom from biochemical failure (FFbF). Kaplan-Meier analyses, life-tables, and log-rank tests were used to identify variables that were predictive of 10-year FFbF. RESULTS In this series, a total of 2268 patients included 81% Caucasians, 12% African Americans, 6% Hispanics, and 1% Asians. The 10-year actuarial FFbF rate was 70% for AA men and 84% for all others (P = .002). Between Caucasian men and AA men, the 10-year FFbF rate was 83% versus 70%, respectively (P = .001).There was no significant difference in 10-year FFbF between Caucasian men and Hispanic men (83% vs 86%, respectively; P = .6). The 10-year FFbF rate for Hispanic men and AA men was 86% versus 70%, respectively (P = .062). A greater percentage of AA men presented with higher prostate-specific antigen levels (PSA) (>10 ng/mL; 44% vs 21%; P < .001) and, thus, with higher risk disease (24% vs 15%; P < .001) compared with Caucasian men. Among the men with low-risk disease, the 10-year FFbF rate was 90% for Caucasian men and 76% for AA men (P = .041). The 10-year BDFS rate for patients who received brachytherapy alone was 86% for Caucasian men and 61% for AA men (P = .001); however, this difference was not observed when brachytherapy was combined with androgen-deprivation therapy(ADT) with or without supplemental external-beam radiotherapy (EBRT). Multivariate analysis revealed that PSA (P = .024), Gleason score (P < .001), the biologic effective dose (P < .001), EBRT (P = .002), ADT (P = .03), and AA race (P = .037) were significant predictors of 10-year FFbF. No significant differences was observed in overall survival, cause-specific survival, or distant metastasis-free survival between racial groups. CONCLUSIONS AA race appeared to be an independent negative predictor of BDFS after prostate brachytherapy, and this result may highlight the need for more aggressive therapy in this patient population.
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Affiliation(s)
- Kosj Yamoah
- Department of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, USA.
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