Abstract: PD10-05
Sources of Funding: none

Introduction

African American (AA) men suffer from a disproportionately high burden of clinically significant prostate cancer, with an increased risk of aggressive or advanced stage disease. Even among men thought to have low risk disease at diagnosis, data suggests that AA men are at an increased risk of adverse pathology after radical prostatectomy (RP) compared to men of other races. These data suggest an underestimation of disease risk at diagnosis among AA men. In the current study, we compared pre- and post-treatment estimates of prostate cancer risk, to determine whether inaccurate assessment of disease risk at diagnosis differs by race.

Methods

We identified Caucasian and AA men who underwent radical prostatectomy (RP) at our institution between 2012 to 2016. CAPRA and CAPRA-S scores were determined as estimates of pre- and post-operative disease risk, and differences between each patient's CAPRA and CAPRA-S scores were calculated. Underestimation of disease risk at diagnosis was defined as a CAPRA score less than CAPRA-S score. Rates of risk under and over-estimation were compared among racial groups, and multivariable logistic regression was used to determine factors associated with risk underestimation.

Results

391 men met inclusion criteria, including 284 Caucasian (72.6%) and 107 AA (27.4%) men. As shown in table 1, the distribution of CAPRA and CAPRA-S scores did not differ significantly by race (CAPRA p=0.81, CAPRA-S p=0.69). Differences between each individual patient's CAPRA and CAPRA-S score are shown in table 2. Risk underestimation occurred in 37% of AA men, compared to 26% of Caucasian men (p = 0.09). Multivariable logistic regression showed that AA race (p = 0.05) and higher serum PSA at diagnosis (p = 0.01) were associated with risk underestimation, whereas age at biopsy, Gleason score, and clinical stage were not.

Conclusions

Underestimation of prostate cancer risk at diagnosis appears to be more common in AA compared to Caucasian men. These findings suggest a need for improved risk assessment at diagnosis, and argue for more aggressive treatment of prostate cancer in AA men.

Funding

none