Active surveillance for Black men with low-risk prostate cancer-An editorial

An editorial focused on racial disparity concerning active surveillance for men with low-risk prostate cancer.  A retrospective cohort analysis of 2280 Black patients and 6446 White patients with low-risk prostate cancer who underwent active surveillance in the Veterans Health Administration (VHA) Health Care System reported that at 10 years of follow-up higher rates of disease progression (59.9% vs 48.3%) and definitive treatment (54.8% vs 41.4%) were observed among Black patients compared with White patients, but there were no significant differences in the development of metastases (1.5% vs 1.4%), the prostate cancer death rates (1.1% vs 1.0%), or overall mortality (22.4% vs 23.5%). 

The editorial also cited another recent study that provides complementary evidence that racial disparities in prostate cancer outcomes can be reduced by equal access to care.  A separate analysis of data from the national SEER (Surveillance, Epidemiology, and End Results) registries reported that Black patients had higher rates of prostate cancer deaths, although this difference was not observed in the VHA or in the clinical trial cohorts where there was equal access to care. Taken together, these results suggest that these racial disparities can be addressed, and biological differences between the cancers of Black versus White patients can be overcome.  Hence, in an equal-access health care system, active surveillance appears comparably safe for Black and White men, but further studies are needed to demonstrate this in clinical settings outside of the VHA system. Until such evidence is available, it is concerning that Black men may continue to have lower rates of active surveillance.

JAMA 324.17 (2020): 1733–1734.