While National Comprehensive Cancer Network (NCCN) practice guidelines for prostate cancer advise that active surveillance is usually appropriate for men with very low-risk prostate cancer and a life expectancy ≤ 20 years, a Johns Hopkins study suggests that outcomes for African American men considering active surveillance are not equivalent to those in Caucasian men who meet the NCCN criteria for very low-risk disease.

This discrepancy may prompt questions from patients considering their options for prostate cancer. African American men considering active surveillance “should be counseled that their disease-free outcomes may not parallel currently published oncologic outcomes from large [active surveillance] cohorts,” stated the study ­authors.

“The important point is not to say that active surveillance is right or wrong for African American men, but it is important to highlight that there is a discrepancy in the outcomes for African American vs Caucasian men,” the study’s corresponding author, Edward M. Schaeffer, MD, PhD, told The ASCO Post. “We are basing a lot of our advice about expected outcomes on series that are predominantly Caucasian men. That is a previously unrecognized deficiency that we have to address.”

Race-Based Risk Tables

Researchers at Johns Hopkins University School of Medicine are addressing the issue by developing risk assessment tables for men of different races diagnosed with prostate cancer. “The idea would be that if an African American or a young white man came to the clinic, we would be able to determine—based on risk factors that we now believe should include race—the ‘riskiness’ of his cancer,” Dr. Schaeffer said.

These race-based risk tables are currently in the review phase, Dr. Schaeffer noted. Still in the development phase are modified criteria that African American men can use to determine whether to choose active surveillance or more immediate treatment.

For African American men who are considering active surveillance, “we highly recommend magnetic resonance imaging (MRI),” Dr. Schaeffer said. “An MRI of the prostate will be able to help us image these tumors that might have been missed on biopsy. That is the premise. Whether or not that is going to be effective will have to be studied prospectively.” ■