PSA Velocity and Disease Progression in Black Versus Non-Hispanic White Men With Prostate Cancer
Posted: Monday, July 26, 2021
According to research presented in JAMA Network Open, there may be a significant association between prostate-specific antigen (PSA) velocity and clinical disease progression for patients with low-risk prostate cancer who are undergoing active surveillance. However, PSA velocity thresholds associated with disease progression may be substantially lower for Black men than for non-Hispanic White men.
“These data suggest that serial PSA measures may potentially substitute for multiple prostate biopsies and that African American patients may merit increased frequency of PSA testing,” concluded Brent S. Rose, MD, of the University of California, San Diego, and colleagues.
The retrospective study included 5,296 men with low-risk prostate cancer who had been diagnosed with localized disease between January 1, 2001, and December 21, 2015, and whose treatment plan included active surveillance. A total of 3,919 participants (74%) were non-Hispanic White and 1,377 (26%) were Black.
A total of 2,062 patients (38.9%) experienced disease progression to at least International Society of Urologic Pathology grade group 2, a cumulative incidence of 43.2%. A total of 728 men (13.7%) experienced disease progression to at least grade group 3. Metastases developed in 54 patients (1%). A significant association was observed between progression to grade group 2, progression to grade group 3, and disease metastases. Black patients had progression-associated PSA velocity thresholds that were much lower (0.44 ng/mL/y) than those of non-Hispanic White patients (1.18 ng/mL/y).
Patient records were sourced from the Veterans Health Administration Informatics and Computing Infrastructure. Median patient age was 65.7 years for non-Hispanic White patients and 62.8 years Black patients. Overall, non-Hispanic White patients presented with a higher clinical tumor stage, had a higher Charlson Comorbidity Index score, had a higher median income, and had a higher median level of education versus Black patients.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
