Very Low-Risk Cancer Not Black & White

Prostate cancer classified as very low risk more aggressive in black men

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Recently, men have been told to consider carefully watching instead of immediately treating prostate cancer. These recommendations reflect the fact that, in many men, prostate cancer is slow growing and may never cause a problem.

Black men need to be especially careful when choosing to watch their prostate cancer because the disease tends to behave differently in them than it does in white men. 

A new study has found that even very low-risk prostate cancers were more likely to be aggressive in black men than in white men.

As a result of these findings, the researchers suggested that "active surveillance" may not be a safe option for black men.

"Discuss all of your cancer treatment options with your oncologist."

Edward M. Schaeffer, MD, PhD, associate professor of urology, oncology and pathology at the Johns Hopkins University School of Medicine in Baltimore, was a co-author of this study.

"This is critical information because if African-American men do have more aggressive cancers, as statistics would suggest, then simply monitoring even small cancers that are very low-risk would not be a good idea because aggressive cancers are less likely to be cured," Dr. Schaeffer said in a prepared statement.

Prostate cancer in black men tends to appear in different regions of the prostate — areas that are hard to reach with biopsies. Black men also develop more serious forms of the disease, or what doctors call higher grade tumors.

This study involved 1,729 men — 1,473 white men and 256 black men. The average age of study members was 58 years.

All of the men were classified as having very low-risk prostate cancer according to National Comprehensive Cancer Network (NCCN) criteria at diagnosis.

The participants had had their prostates removed in a procedure known as "radical prostatectomy."

After analyzing the tumors, the researchers found that the black men had more advanced levels of disease than the white men. 

After surgery, 27.3 percent of the black men were found to have more advanced disease than was described at diagnosis, compared to 14.4 percent of white men.

Disease was found in tissue surrounding the prostate in 9.8 percent of the black men versus 5.9 percent of the white men.

The black men also had higher scores than the white men on the Cancer of the Prostate Risk Assessment scoring system, which measures the aggressiveness of the disease.

Dr. Shaeffer, who is director of global urologic services for Johns Hopkins Medicine International and co-director of the Prostate Cancer Multi-Disciplinary Clinic at The Johns Hopkins Hospital’s James Buchanan Brady Urological Institute, said that the system used to define very low-risk prostate cancer works well in white men because classification systems are based on white men.

He added, "Among the vast majority of African-American males with very low-risk cancer who underwent surgical removal of the prostate, we discovered that they face an entirely different set of risks."

E. David Crawford, MD, professor of surgery, urology and radiation oncology and head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center (UCHSC) in Denver, told dailyRx News, "In the past 18 months, a number of prestigious organizations have discouraged early detection efforts for men with prostate cancer. Part of the foundation of these recommendations was that active surveillance was appropriate in most men."

Dr. Crawford continued, "The internationally renowned researchers at Johns Hopkins point out that the group of men who are at highest risk of developing prostate cancer, black men, do not parallel non-Hispanic white men in outcomes for active surveillance.

"We need better ways to select men for active surveillance such as newly developed markers — Oncotype DX and Prolaris," Dr. Crawford said.

Dr. Crawford has consulted with Myriad Genetics, the manufacturer of the Prolaris test. 

The study authors concluded the results of their study illustrate "...the need to develop and use race-based risk classifiers when counseling patients about different management strategies.

"The results of our study do not support the universal rejection of active surveillance in African American men, but rather should promote future studies to address whether alternate race-specific surveillance entry criteria should be used for African American men..."

In the meantime, "African American men with very low-risk prostate cancer should be counseled about increased oncologic risk when they choose their disease management options," the authors wrote.

This research was published June 17 in the Journal of Clinical Oncology

The study was funded by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases, the American Urological Association Foundation’s Astellas Rising Star Award and the Howard Hughes Medical Institute’s Physician-Scientist Early Career Award.

No conflicts of interest were disclosed.

Reviewed by: 
Review Date: 
July 2, 2013
Last Updated:
July 30, 2013