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'Active surveillance' may miss aggressive prostate cancers in black men
Date:6/25/2013

e based on blood levels of prostate specific antigen, Gleason score, lymph node involvement, extracapsular extension, seminal vesicle invasion, and positive surgical margins. Schaeffer and his team say their data suggest that "very-low-risk" African-Americans have different regional distributions of their cancers and appear to also develop more high-grade cancers. Researchers added that these tumors hide in the anterior prostate a region that is quite difficult to assess using current biopsy techniques.

All study participants, of whom 1,473 were white and 256 black, met current National Comprehensive Cancer Network (NCCN) criteria for very-low-risk prostate cancer, and were thus good candidates for AS. The study showed that preoperative characteristics were similar for very-low-risk whites and blacks, although black men had slightly worse Charlson comorbidity index scores, a commonly used scale for assessing life expectancy. Detailed analysis showed that black men had a lower rate of organ-confined cancers (87.9 percent vs. 91.0 percent), a higher rate of Gleason score upgrading (27.3 percent vs. 14.4 percent) and a significantly higher hazard of prostate-specific antigen (PSA) defined biochemical recurrence (BCR) of prostate cancer. The latter measure is widely used for reporting the outcome of surgical prostate removal.

According to Schaeffer, the median age of men in his study was 58, younger than the median ages (62 to 70) of most men in AS groups. And he cautioned that the age difference is a potential "confounder" of his results, highlighting the need for more studies to gauge the safety of AS.

Schaeffer, associate professor of urology, oncology and pathology at the Johns Hopkins University School of Medicine and 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, emp
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Contact: John Lazarou
jlazaro1@jhmi.edu
410-502-8902
Johns Hopkins Medicine
Source:Eurekalert

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