Statistics show that black men are diagnosed with prostate cancer at a higher rate and they die from prostate cancer at a higher rate than white men. So that got researchers at the Fred Hutchinson Cancer Research Center to ponder whether “active surveillance” would help blacks reap the same benefit as white counterparts instead of heading straight into surgery or radiation.
Using data from more than 1,300 men, 89 of whom self-identified as African American, all the men had similar diagnoses and a family history of prostate cancer; all experienced the same number of follow-up biopsies and prostate-specific antigen (PSA) tests.
After following the men for a median of 3.9 years and analyzing the data (neither genetic nor genomic sequencing was done), the researchers found race was not a factor in determining whether a man’s cancer would become more aggressive.
“There have been some conflicting reports as to whether it’s safe to use active surveillance in African American men,” said Dr. Daniel Lin, principle investigator of the Canary Prostate Active Surveillance Study. “One report said they might have slightly higher rates of finding worse cancers during active surveillance, but that was a smaller study.
“We had more African American men in our cohort and found there was no difference between the men who did active surveillance; no difference between blacks and whites.”
Around one-third of early-stage prostate cancers are slow-growing and low risk. Radical treatments aren’t necessarily beneficial in these cases. Instead, these men can be monitored through “active surveillance,” the standard of care recommended by national cancer organizations such as the American Society of Clinical Oncology.
In this approach, men diagnosed with early-stage disease receive regular PSA testing, biopsies and digital-rectal exams to keep tabs on their cancer. Active surveillance is different from another less-vigilant approach often used in older men called “watchful waiting.”
Lin said that out of 100 patients who start active surveillance, 50% will go on to have treatment within the first 10 years. “But half are still free of being treated,” he said. “The men in this study are hoping to avoid treatment because of side effects such as incontinence or leakage or erectile dysfunction.”
Treatment for prostate cancer usually involves a radical prostatectomy and/or radiation, and each treatment approach can come with considerable collateral damage.
“We know that for decades we overtreated men with low-grade prostate cancer,” Lin said. “We caused a lot of comorbidity – physical damage – and a lot of sexual dysfunction. More than half of men with prostate cancer will live with it and die with it. Not of it.”
Lin and fellow Canary PASS researchers – 11 study sites are involved in the collaboration – hope to curb overtreatment of the disease by better utilizing practices like active surveillance.
To that end, researchers at Fred Hutchinson Cancer Research Center received a five-year, $6.7 million grant from the National Cancer Institute to support the infrastructure and ongoing growth of the multicenter Canary PASS. (2)
“PASS was launched with six participating centers in 2008,” said PASS Deputy Director Dr. Lisa Newcomb, a Fred Hutchinson cancer prevention researcher. “With this grant, we’ll be up to 11 sites. Fred Hutch is the centralized repository – specimens are sent to the Hutch from all the sites – and we have procedures for sharing the data and the specimens among the group [members] and with other researchers.
“The clinical data that is collected – and available on any of these active-surveillance patients – is very powerful,” she said. “But it’s used in bits and pieces. We know we can do more with it. And we’re working on that.”
Citations
- Black men with early-stage prostate cancer can do active surveillance. https://www.fredhutch.org/en/news/center-news/2019/11/black-men-prostate-cancer-active-surveillance.html
- Fred Hutch receives 5 years of NCI funding to grow and maintain key prostate cancer cohort. https://www.fredhutch.org/en/news/center-news/2019/11/prostate-cancer-study-nci-funding-grant.html