Prostate cancer: watchful waiting less likely in black patients

  • Butler S & al.
  • N Engl J Med
  • 23 May 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • During 2010-2015, use of active surveillance nearly tripled in patients with low-risk prostate cancer.
  • Black patients were less likely to receive active surveillance compared with nonblack patients.
  • Socioeconomic and insurance status may be associated with lower odds of active surveillance in black patients.

Why this matters

  • Black patients are underrepresented in clinical trials that evaluated active surveillance.
  • Studies to guide management for black men with low-risk prostate cancer are warranted.

Study design

  • Study of 50,302 patients with low-risk prostate cancer between 2010 and 2015.
  • Funding: American Society for Radiation Oncology; the Prostate Cancer Foundation.

Key results

  • 14.9% of patients were black.
  • During 2010-2015, the use of radical prostatectomy and definitive radiotherapy decreased:
    • Black patients: from 41.4% and 46.0% to 28.8% and 34.8%, respectively (P<.001>
    • Nonblack patients: from 48.5% and 36.7% to 31.8% and 24.9%, respectively (P<.001>
  • Use of active surveillance increased:
    • Black patients: 12.6% to 36.4% (P<.001>
    • Nonblack patients: 14.8% to 43.3% (P<.001>
    • Black men had lower odds of receipt of active surveillance vs nonblack men (aOR, 0.93; P=.02); the association was not significant after adjusting for socioeconomic and insurance status (aOR, 1.01; P=.86).

Limitations

  • Observational design.

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