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Guerrios‐Rivera L, Janes JL, De Hoedt AM, Klaassen Z, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Aronson WJ, Fowke JH, Freedland SJ. Do Hispanic Puerto Rican men have worse outcomes after radical prostatectomy? Results from SEARCH. Cancer Med 2024; 13:e7012. [PMID: 38457188 PMCID: PMC10922022 DOI: 10.1002/cam4.7012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND We previously reported that outcomes after radical prostatectomy (RP) were similar among non-Hispanic Black, non-Hispanic White, and Hispanic White Veterans Affairs (VA) patients. However, prostate cancer (PC) mortality in Puerto Rican Hispanics (PRH) may be higher than in other Hispanic groups. Data focused on PRH patients is sparse; thus, we tested the association between PR ethnicity and outcomes after RP. METHODS Analysis included men in SEARCH cohort who underwent RP (1988-2020, n = 8311). PRH patients (n = 642) were treated at the PR VA, and outcomes were compared to patients treated in the Continental US regardless of race. Logistic regression was used to test the associations between PRH and PC aggressiveness, adjusting for demographic and clinicopathological features. Multivariable Cox models were used to investigate PRH versus Continental differences in biochemical recurrence (BCR), metastases, castration-resistant PC (CRPC), and PC-specific mortality (PCSM). RESULTS Compared to Continental patients, PRH patients had lower adjusted odds of pathological grade group ≥2 (p < 0.001), lymph node metastasis (p < 0.001), and positive margins (p < 0.001). In contrast, PRH patients had higher odds of extracapsular extension (p < 0.001). In Cox models, PRH patients had a higher risk for BCR (HR = 1.27, p < 0.001), metastases (HR = 1.49, p = 0.014), CRPC (HR = 1.80, p = 0.001), and PCSM (HR = 1.74, p = 0.011). Further adjustment for extracapsular extension and other pathological variables strengthened these findings. CONCLUSIONS In an equal access setting, PRH RP patients generally had better pathological features, but despite this, they had significantly worse post-treatment outcomes than men from the Continental US, regardless of race. The reasons for the poorer prognosis among PRH men require further research.
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Affiliation(s)
- Lourdes Guerrios‐Rivera
- Urology Section, Surgery DepartmentVeterans Administration Caribbean Healthcare SystemSan JuanPuerto Rico
- University of Puerto Rico, Medical Sciences CampusSan JuanPuerto Rico
| | - Jessica L. Janes
- Section of Urology, Division of SurgeryDurham VA Health Care SystemDurhamNorth CarolinaUSA
| | - Amanda M. De Hoedt
- Section of Urology, Division of SurgeryDurham VA Health Care SystemDurhamNorth CarolinaUSA
| | - Zachary Klaassen
- Department of Surgery, Section of UrologyAugusta University – Medical College of GeorgiaAugustaGeorgiaUSA
- Charlie Norwood VA Medical CenterAugustaGeorgiaUSA
| | - Martha K. Terris
- Department of Surgery, Section of UrologyAugusta University – Medical College of GeorgiaAugustaGeorgiaUSA
- Charlie Norwood VA Medical CenterAugustaGeorgiaUSA
| | - Matthew R. Cooperberg
- Department of UrologyDiller Family Comprehensive Cancer Center, UCSF HelenSan FranciscoCaliforniaUSA
| | - Christopher L. Amling
- Department of UrologyOregon Health and Science University School of MedicinePortlandOregonUSA
| | - Christopher J. Kane
- Department of UrologyUC San Diego Health SystemSan DiegoCaliforniaUSA
- VA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - William J. Aronson
- Department of UrologyUCLA Medical CenterLos AngelesCaliforniaUSA
- Wadsworth VA Medical CenterLos AngelesCaliforniaUSA
| | - Jay H. Fowke
- Division of Epidemiology, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Epidemiology, Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Stephen J. Freedland
- Section of Urology, Division of SurgeryDurham VA Health Care SystemDurhamNorth CarolinaUSA
- Center for Integrated Research in Cancer and Lifestyle, Division of Urology, Department of SurgerySamuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
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Hougen HY, Iakymenko OA, Punnen S, Ritch CR, Nahar B, Parekh DJ, Kryvenko ON, Gonzalgo ML. Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy. World J Urol 2022; 40:2017-2023. [PMID: 35689106 DOI: 10.1007/s00345-022-04065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. METHODS We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. RESULTS Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. CONCLUSIONS HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.
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Affiliation(s)
- Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.
| | - Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Guerrios-Rivera L, Howard LE, Klaassen Z, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Aronson WJ, Freedland SJ. Do Hispanic Men Have Worse Outcomes After Radical Prostatectomy? Results From SEARCH. Urology 2021; 149:181-186. [PMID: 33189734 DOI: 10.1016/j.urology.2020.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the associations between ethnicity and outcomes after radical prostatectomy (RP) among Hispanics. While non-Hispanic Black men have worse prostate cancer (PC) outcomes, there are limited data on outcomes of Hispanic men, especially after RP. METHODS We identified 3789 White men who underwent RP between 1988 and 2017 in the Shared Equal Access Regional Cancer Hospital database. Men were categorized as Hispanic or non-Hispanic. Logistic regression was used to test the association between ethnicity and PC adverse features. Cox models were used to test the association between ethnicity and biochemical recurrence (BCR), metastases, and castration-resistant PC (CRPC). All models were adjusted for age, prostate-specific antigen, clinical stage, biopsy grade group, surgery year, and surgical center. RESULTS Of 3789 White men, 236 (6%) were Hispanic. Hispanic men had higher prostate-specific antigen, but all other characteristics were similar between ethnicities. On multivariable analysis, there was no difference between ethnicities in odds of extracapsular extension, seminal vesicle invasion, positive margins, positive lymph nodes, or high-grade disease (odds ratio 0.62-0.89, all P > .07). A total of 1168 men had BCR, 182 developed metastasis, and 132 developed CRPC. There was no significant association between Hispanic ethnicity and risk of BCR, metastases, or CRPC (hazards ratio 0.39-0.85, all P > .06). CONCLUSION In an equal access setting, we found no evidence Hispanic White men undergoing RP had worse outcomes than non-Hispanic White men. In fact, all hazard ratios were <1 and although they did not achieve statistical significance, suggest perhaps slightly better outcomes for Hispanic men. Larger studies are needed to confirm findings.
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Affiliation(s)
- Lourdes Guerrios-Rivera
- Urology Section, Surgery Department, Veterans Administration Caribbean Health Care System, San Juan, Puerto Rico; University of Puerto Rico, Medical Sciences Campus
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, NC; Section of Urology, Division of Surgery, Durham VA Medical Center, Durham, North Carolina
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Augusta University - Medical College of Georgia, Georgia
| | - Martha K Terris
- Department of Surgery, Section of Urology, Augusta University - Medical College of Georgia, Georgia; Section of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA
| | | | - Christopher L Amling
- Department of Urology, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - Christopher J Kane
- Department of Urology, University of California, San Diego CA; VA San Diego Healthcare System, San Diego, California
| | - William J Aronson
- Department of Urology, University of California, Los Angeles, California; Wadsworth VA Medical Center, Los Angeles, California
| | - Stephen J Freedland
- Section of Urology, Division of Surgery, Durham VA Medical Center, Durham, North Carolina; Center for Integrated Research in Cancer and Lifestyle, Division of Urology, Department of Surgery, and the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Abstract
Hispanics/Latinos are the largest and fastest growing major demographic group in the United States, accounting for 16.3% (50.5 million/310 million) of the US population in 2010. In this article, the American Cancer Society updates a previous report on cancer statistics for Hispanics using incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. In 2012, an estimated 112,800 new cases of cancer will be diagnosed and 33,200 cancer deaths will occur among Hispanics. In 2009, the most recent year for which actual data are available, cancer surpassed heart disease as the leading cause of death among Hispanics. Among US Hispanics during the past 10 years of available data (2000-2009), cancer incidence rates declined by 1.7% per year among men and 0.3% per year among women, while cancer death rates declined by 2.3% per year in men and 1.4% per year in women. Hispanics have lower incidence and death rates than non-Hispanic whites for all cancers combined and for the 4 most common cancers (breast, prostate, lung and bronchus, and colorectum). However, Hispanics have higher incidence and mortality rates for cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, differences in lifestyle and dietary patterns, and possibly genetic factors. Strategies for reducing cancer risk among Hispanics include increasing utilization of screening and available vaccines, as well as implementing effective interventions to reduce obesity, alcohol consumption, and tobacco use.
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Affiliation(s)
- Rebecca Siegel
- Surveillance Information, Surveillance Research, American Cancer Society, Atlanta, GA 30303, USA.
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Song C, Ro JY, Lee MS, Hong SJ, Chung BH, Choi HY, Lee SE, Lee E, Kim CS, Ahn H. Prostate cancer in Korean men exhibits poor differentiation and is adversely related to prognosis after radical prostatectomy. Urology 2006; 68:820-4. [PMID: 17070360 DOI: 10.1016/j.urology.2006.04.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 03/24/2006] [Accepted: 04/25/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the clinical and pathologic characteristics of prostate cancer in Korean men to determine how ethnic differences affect clinical outcome. METHODS The clinical and pathologic data of 604 Korean men who underwent radical prostatectomy from 1994 to 2003 were reviewed. Biochemical failure was defined as a prostate-specific antigen (PSA) level of 0.2 ng/mL or greater on two consecutive occasions after having achieved an undetectable PSA level. Patient distribution with respect to the clinical and pathologic parameters and biochemical failure rates were compared with those of contemporary Western series. RESULTS The mean preoperative PSA level was 9.9 ng/mL (range 0.4 to 38.8) and the median biopsy Gleason score was 7. The Gleason score was 7 in 186 patients (30.8%) and greater than 7 in 169 (28.0%). Gleason scores stratified with respect to clinical stage and PSA range revealed the proportion of patients with high Gleason scores (7 or greater) to be more than 50% of each subgroup throughout the clinical stages and PSA ranges. At a median follow-up of 57.9 months (range 22 to 131), biochemical failure occurred in 24.2% of all patients and in 14.3% of those with an initial serum PSA level of 10.0 ng/mL or lower. On multivariate Cox regression analysis, the Gleason score showed the strongest statistical significance for biochemical failure (P = 0.001, hazard ratio 1.376, 95% confidence interval 1.056 to 1.792) for patients with a serum PSA level of 10.0 ng/mL or lower. CONCLUSIONS A significant proportion of prostate cancers arising in Korean men exhibit poor differentiation, regardless of the initial serum PSA level or clinical stage at presentation, and adversely affect prognosis, causing a greater rate of PSA failure.
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Affiliation(s)
- Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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