At the time of radical prostatectomy for prostate cancer, black men are more likely to have adverse pathologic features. Independent of socioeconomic and clinical factors, investigators came to this conclusion in a study presented at a Cancer Symposium.
According to researchers, these adverse pathologic features increase their risk of biochemical recurrence and more frequently lead to an indication for adjuvant radiation therapy.
Using the National Cancer Database, the investigators identified 313,013 men diagnosed with PCa from 2004 to 2014 and who underwent RP. The group included 256,315 whites (85%), 33,725 blacks (11%), and 12,973 patients of other races.
Significantly higher proportions of blacks than whites had Gleason grade group 2 cancer (46% vs 37.7%), PSA levels of 10 ng/mL or higher (18.5% vs 15.9%), and clinical stage T2b disease (17.8% vs 13.8%).
On multivariable analysis, the odds of having indications for adjuvant radiotherapy (pT3 disease or higher or positive surgical margins) were 21% greater among blacks than whites. Blacks had 26% greater odds of having positive surgical margins, but 23% lower odds of having pT3 or higher disease.
As for what might explain the findings, it was noted that black men may be more likely to harbor certain genetic polymorphorisms that give rise to more aggressive PCa. An autopsy study revealed that black men are more likely to have cancer in the anterior of their prostate, which could be a cause of pathologic upstaging. Another possibility is the low vitamin D, which has been linked to an increased risk of aggressive cancer. Black people in general have low vitamin D levels, possibly as a result of their darker skin.