Conservative Management of Prostate Cancer in Veterans: Racial Comparison
Posted: Monday, November 16, 2020
For U.S. Black veterans, conservative management of low-risk and intermediate-risk prostate cancer is less common and “less durable” than in White veterans, according to findings presented in JAMA Network Open. African American veterans who received conservative therapy, noted Ravishankar Jayadevappa, PhD, of the University of Pennsylvania, Philadelphia, and colleagues, were also more likely to receive definitive therapy within 5 years of diagnosis.
“Future prospective research should study the effectiveness of conservative management in African American men with low-risk and intermediate-risk prostate cancer to determine whether race-specific recommendations regarding conservative management are warranted,” the authors concluded.
In this cohort study, the authors used data from the U.S. Department of Veteran Affairs (VA) Corporate Data Warehouse. They analyzed 51,543 Black, and non-Hispanic White veterans deemed low risk or intermediate risk for localized node-negative prostate cancer between 2004 and 2013. All patients had a diagnosis of prostate cancer and had at least one encounter with the VA. All patients received either definitive therapy such as prostatectomy, radiation therapy, and androgen-deprivation therapy or conservative management such as active surveillance or watchful waiting.
The cohort included 14,830 Black veterans (28.8%). These patients seemed to be more likely to have intermediate disease than did White veterans (57.3% vs. 51.7%, respectively), three or more comorbidities (51.3% vs. 42.1%, respectively), and high disability–related or income-related needs (31.1% vs. 24.7%, respectively.)
Of the population, 20,606 veterans (40.0%) received conservative management, with Black veterans who had low-risk and intermediate-risk disease being less likely to receive this care than White veterans. Those Black veterans with low-risk and intermediate-risk disease who did receive conservative management tended to be more likely to receive definitive therapy within 5 years of diagnosis than White veterans.
Disclosure: For full disclosure of the study authors, visit jamanetwork.com.