Waiting game.

A major limitation of many prostate cancer active surveillance (AS) studies is the low number of African American participants. On the one hand, we don’t want to pursue AS in a group of men who aren’t as “low risk” as we might assume. But on the other hand we don’t want to withhold AS from men who may do perfectly fine and be able to delay or avoid treatment. We need some data, folks. In this retrospective cohort study from the VA Health System, nearly 9000 men underwent initial active surveillance for low risk prostate cancer and had at least one surveillance biopsy. Importantly, a whopping 26% of these men were African American. At 10 years, they had a significantly higher rate of disease progression (48.3 → 59.9%) and treatment initiation (41.4 → 54.8%). However, there was no significant difference in the rate of distant metastasis (1.4 and 1.5%), prostate cancer mortality (1.1 and 1.0%), or all-cause mortality. TBL: African American men with low-risk prostate cancer on active surveillance have a higher risk of disease progression and a higher likelihood of treatment, but (at least over 10 years) that doesn’t translate into an increased risk of distant mets or worse prostate cancer mortality. | Deka, JAMA 2020

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