Active Surveillance/Watchful Waiting for Black Patients With Low-Risk Prostate Cancer
In a study reported in a letter to the editor in The New England Journal of Medicine, Butler et al found that the proportion of black patients with low-risk prostate cancer undergoing active surveillance remained lower than that among nonblack patients, despite increased use of the strategy in both populations during recent years.
Study Details
The study involved data from the Surveillance, Epidemiology, and End Results Prostate With Watchful Waiting Database from patients with low-risk prostate cancer, defined as clinical stage of T1 to T2a, Gleason score of ≤ 6, and prostate-specific antigen level < 10 ng/ml diagnosed between 2010 and 2015 for whom management type was known. Of 50,302 patients, 7,517 (14.9%) were black and 42,785 (85.1%) were nonblack.
Use of Active Surveillance/Watchful Waiting
From 2010 through 2015, the use of radical prostatectomy and definitive radiotherapy decreased from 41.4% and 46.0% to 28.8% and 34.8%, respectively, among black patients and from 48.5% and 36.7% to 31.8% and 24.9%, respectively, among nonblack patients (P < .001 for trend). Over this period, use of active surveillance or watchful waiting increased from 12.6% to 36.4% among black patients and from 14.8% to 43.3% among nonblack patients (P < .001 for trend).
In analysis not adjusted for socioeconomic or insurance status, black men had lower likelihood of receiving active surveillance or watchful waiting (adjusted odds ratio [OR] = 0.93, P = .02). No significant difference in likelihood according to race was found when analysis was adjusted for socioeconomic status and insurance status (adjusted OR = 1.01, P = .86). For 2010 through 2015, multivariable adjusted ORs for use of active surveillance or watchful waiting for black vs nonblack men were: 1.06 (P = .52) in 2010; 1.24 (P = .004) in 2011; 0.97 (P = .72) in 2012; 1.01 (P = .86) in 2013; 0.92 (P = .31) in 2014; and 0.84 (P = .02) in 2015 (P = .02 for trend).
The investigators concluded, “From 2010 through 2015, the use of active surveillance or watchful waiting nearly tripled among both black men and nonblack men. Multivariable analyses suggest that racial differences in the receipt of active surveillance or watchful waiting may be driven by differences in socioeconomic status. Still, black men were less likely than nonblack men to receive active surveillance or watchful waiting by 2015, even after adjustment for socioeconomic status—a finding that suggests a possible lower relative uptake of active surveillance or watchful waiting over time for black men.”
Disclosure: The study was supported by the American Society for Radiation Oncology, Prostate Cancer Foundation, and Department of Health and Human Services. For full disclosures of the study authors, visit nejm.org.
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