Study Finds Racial Differences in Conservative Management of Low- to Intermediate-Risk Prostate Cancer among Veterans
BACKGROUND:
Conservative management (active surveillance or watchful waiting) of low- or intermediate-risk prostate cancer is a guideline-based alternative to definitive therapy (prostatectomy, radiation, androgen deprivation therapy). Rates of conservative management have increased substantially over the past decade. However, the possibility of race-based biological differences in low-risk prostate cancer has led to a debate about whether African Americans should be candidates for conservative management. This study sought to determine whether there are any racial differences in the receipt and duration of conservative management among Veterans treated in the VA healthcare system. Using VA data from January 2004 through December 2018, investigators identified 51,543 Veterans (14,830 or 29% were African American) with low- or intermediate-risk prostate cancer who received either definitive therapy or conservative management. Covariates included age at diagnosis, pre-treatment PSA, VA enrollment priority group, marital status, comorbidities, and urban vs. rural location.
FINDINGS:
- African American Veterans were slightly less likely to receive conservative management than White Veterans with localized prostate cancer. [Adjusted relative risk of 0.95 for Veterans with low-risk disease and 0.92 for those with intermediate-risk disease.]
- Further, among patients receiving conservative management, African American Veterans had a higher risk of receiving definitive therapy within five years of diagnosis than White Veterans. The median time to definitive treatment was 719 days for African American Veterans and 787 days for White Veterans.
- Compared to White Veterans, African American Veterans were more likely to have intermediate-risk disease (58% vs. 52%), ≥3 comorbidities (51% vs. 42%), and high disability- or income-related needs (31% vs. 25%).
IMPLICATIONS:
- Conservative management for low- and intermediate-risk prostate cancer may be less durable for African American Veterans compared to White Veterans. Future research should study the effectiveness of conservative management in African American men to determine if race-specific recommendations regarding conservative management are warranted.
LIMITATIONS:
- This study's dataset of routinely collected data did not contain information regarding prostate volume, which may factor into decisions about pursuing active surveillance.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Parikh and Chhatre are part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP).
Parikh R, Robinson K, Chhatre S, et al. Comparison by Race of Conservative Management for Low-Risk and Intermediate-Risk Prostate Cancers in Veterans: 2004-2018. JAMA Network Open. September 28, 2020;3(9):e2018318.
