Pathological outcome and biochemical recurrence‐free survival after radical prostatectomy in African‐American, Afro‐Caribbean (Jamaican) and Caucasian‐American men: an international comparison. (26th October 2012) - Ritch, Chad R.
Abstract : What's known on the subject? and What does the study add? It is known that men of African descent in the USA and Jamaica have both a higher incidence of prostate cancer and higher mortality than Caucasian men, but it is unclear whether they have worse pathological and biochemical recurrence (BCR) outcome than their Caucasian counterparts after radical prostatectomy (RP) for prostate cancer. We found that African‐American (AA) men present at a younger age and have a higher mean PSA level than Caucasian‐American (CA) men and that Afro‐Caribbean (AC; Jamaican) men present with the highest mean PSA level, Gleason score and tumour stage of the three groups. In addition, we showed that AA and AC men have a higher likelihood of 5‐year BCR than CA men and that AA and AC race are both independent predictors of BCR after RP. OBJECTIVE: To compare pathological and biochemical outcomes of radical prostatectomy (RP) among African‐American (AA), Afro‐Caribbean (AC; Jamaican) and Caucasian‐American (CA) men using an international cohort of patients who underwent RP in the USA and Jamaica. MATERIALS AND METHODS: A retrospective review was performed of men who underwent RP for clinically organ‐confined (OC) prostate cancer between 2000 and 2011 at Columbia University Medical Center (New York, USA) and the University Hospital of the West Indies (Kingston, Jamaica) between 2000 and 2007. Men who had received neoadjuvant or adjuvant (within 3 months) therapy were excluded. Clinicopathological variables were compared among the three groups, focusing on age, stage, PSA level, Gleason sum (GS) and margin status. Multivariate analysis was performed to determine the predictors of biochemical recurrence (BCR; PSA >0.2 ng/mL), and Kaplan–Meier analysis was performed to determine BCR‐free survival rates in AA, AC and CA men. RESULTS: A total of 483 men underwent RP for clinically OC disease (CM, n = 309, AA, n = 93 and AC, n = 81). The mean patient age was 59 years, with AA men being younger than CA men (58 vs 60 years, P < 0.05). The mean (range) follow‐up was 49 (13–133) months with no significant difference among the groups. The men in the AC cohort had a higher mean PSA level than AA and CA men (8.8 vs 6.2 and 5.0 ng/mL, respectively, P < 0.05) and more clinical GS ≥7 (44%) tumours than AA (8%) and CA men (0%; P < 0.01). On multivariate analysis, controlling for stage, grade, PSA level and margins, AA and AC race were independent predictors of BCR. AA and AC men had significantly lower 5‐year BCR‐free survival (76 and 74%, respectively) than CA men (98% [ P < 0.001]). CONCLUSIONS: This international comparison of clinicopathological outcomes in AA, AC and CA men undergoing RP shows that AA and AC men present similarly with more aggressive disease features than CA men and have lower 5‐year BCR‐free survival. Both AA and AC race are significant predictors of BCR, independently of stage, grade, PSA level and margin status. Further research is needed to elucidate and correct the mechanisms behind the observed difference in outcome among these populations.