Racial Disparities in Active Surveillance Adherence and Quality of Life in a Population-Based Prospective Cohort of Men with Low-Risk Prostate Cancer
Abstract
Background: To date, most newly diagnosed prostate cancers are low-grade and low-risk tumors that are slow-growing and unlikely to harm the patient during their lifetime. Treatment with surgery or radiation often leads to life-changing side effects like urinary incontinence (leakage), erectile dysfunction, and bowel problems. Active surveillance (AS) is a newer management option that involves close monitoring of the tumor with the intent to intervene with curative treatment (surgery or radiation) if there is evidence of cancer progression. The main benefit of AS is to avoid or delay curative treatment and its associated side effects, thus maintaining The patient’s quality of life (QOL). However, whether AS is safe and effective in African American (AA) men is controversial, mainly due to lack of data in this population since existing cohorts largely consist of white men with few AA men included. Our recent research showed AA men are less likely to choose AS than white men. Such disparity may lead to a lost opportunity for improving the QOL of AA survivors and may widen the racial disparity in the QOL of prostate cancer survivors. Objectives/Hypotheses: Guided by the literature and our own findings, we hypothesize that AS is an equally effective and safe management option for AA and white men with low-risk localized prostate cancer (LPC) if they are monitored appropriately (i.e., return for follow-up and testing). However, given AA may have increased risk of cancer progression and a higher risk of loss to follow-up, we also hypothesize that, compared to white men, AA men who initially choose AS have a lower AS adherence rate, higher switch rate from AS to curative treatment, and a shorter time to curative treatment during the first 5 years of follow-up after diagnosis. Specific Aims: We will take advantage of our existing large diverse cohort of patients diagnosed with low-risk prostate cancer during 2014 to 2017 and extend their follow-up to 5 years after diagnosis. These patients have been recruited through two cancer registries (metropolitan Detroit and state of Georgia). All patients who initially chose AS and a subset of patients who chose surgery or radiation at baseline were selected for a follow-up survey at 18 months after baseline to keep track of their treatment status and QOL. Due to the slow progression of low-risk LPC, a follow-up beyond 18 months is necessary to adequately assess all of the outcomes of interest. Aim 1. Identify racial differences in men’s adherence to AS monitoring procedures (e.g., office visits, PSA, biopsy, imaging), switch rates from AS to curative treatment (surgery or radiation), and time to curative treatment over the course of 5 years from diagnosis. Aim 2. Compare QOL measures between the AS group and curative treatment group over the course of 5 years. Aim 3. Evaluate whether reasons for switching from AS to curative treatment differ by race. Study Design: Participants will be recruited from our existing observational cohort of 1,800 (1423 white, 377 AA), all of whom have been diagnosed with low-risk prostate cancer. Among them, approximately 1,100 with completed baseline and 18-month surveys will be eligible for the new follow-up survey at 5 years after diagnosis. The 5-year follow-up survey will be similar to the 18-month survey to assess men’s adherence to AS protocol, switch rates, reasons for switching, time to curative treatment, and QOL over time overall and by race. Additionally, we will include questions regarding the use of newer emerging technologies, such as parametric MRI imaging, genomic testing, and biomarkers, that have been increasingly incorporated in clinical practice to improve AS monitoring. Validation of survey responses related to AS follow-up procedures will be conducted through medical record review. Descriptive and inferential statistical techniques will be used to examine predictors of AS decision, adherence, and QOL. I
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910794
Entities
People
- Jinping Xu
Organizations
- United States Army
- Wayne State University