Active Surveillance for African-American Men with Prostate Cancer
Abstract
Background: There is consensus that many men with early prostate cancer have slow growing cancers that may not need aggressive treatment. Treatment with surgery or radiation often leads to life-changing side effects like urinary incontinence (leakage), erectile dysfunction, and bowel problems. Active surveillance is a management option that is designed to avoid overtreatment of these early cancers. Active surveillance involves close observation with laboratory tests and occasional repeat biopsies. The goal of active surveillance is to monitor these cancers to avoid aggressive treatment in those who do not progress, but retain the chance for curative therapy in those with cancer progression. Active surveillance provides excellent outcomes in most patients with low-risk prostate cancer. Clinical Problem: Whether active surveillance is safe and effective in African American men is controversial, however. African American men are 70% more likely to be diagnosed and 240% more likely to die from prostate cancer than Caucasian men. Physicians attempt to estimate the risk of progression based on laboratory tests and biopsies. These are very effective to identify Caucasian men at low risk of progression. In contrast, these same tests do not seem to be as effective in African American men. Surgeons are more likely to identify more aggressive disease than expected during surgery in African American men. African American men are more likely to have disease progression during active surveillance than Caucasian men. Furthermore, there are almost no long-term data on the outcomes of active surveillance for African American men with low-risk prostate cancer. Objectives: We hypothesize that differences in outcome in African American men are more related to access to medical care than inherently different biology. We hypothesize that African American men in a high quality, equal access health care system can safely undergo active surveillance with rates of disease progression and oncologic outcomes that are comparable to Caucasian men. We will test this hypothesis by studying the outcomes of Caucasian and African American men managed with active surveillance in the Department of Veterans Affairs Health System. Several thousand Caucasian and African American men have been managed with active surveillance in the Veterans Affairs Health Care System, far more than any other published series. We will start by studying rates of disease progression in Caucasian and African American men and then move on to studying long-term outcomes, including the rates of developing metastases or dying from prostate cancer. We will also develop machine learning data analysis techniques that will allow us to identify new patterns in the data that can enhance research and clinical care of men with prostate cancer in the future. Impact: This study will definitively answer the question of whether African American race is an important predictor of aggressive versus indolent disease in men with low-risk prostate cancer. If this study does not find African American race to be an important predictor of aggressive disease, many more African American men will be able undergo active surveillance and avoid the side effects of treatment, including impotence, incontinence, and bowel problems, greatly improving their physical and mental health. Conversely, if African American race is an important predictor of aggressive disease, these data will lead to more patients receiving definitive therapy and therefore reduce the risk of metastases, need for androgen deprivation therapy, and death from prostate cancer. Importantly, these results will be available to help guide treatment decisions in the next couple of years. Career Goals: My career goal is to become a leader in the field of prostate cancer research and clinical care. This project will allow me to develop advanced skills in population sciences, including data modeling, competing risks analys
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810362
Entities
People
- Brenton Rose
Organizations
- United States Army
- University of California, San Diego