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SUO 2017

SUO 2017: Anterior Prostate Lesions and Prostate Cancer Diagnosed in African American Men

Washington, DC (UroToday.com) African American (AA) men often present with higher risk prostate cancer than non-AA men. It is believed that anterior prostate lesions may be greater and more aggressive in AA men leading to evasion of detection, and studies of pathologic specimens have supported this notion [1]. Dr. Gupta and colleagues presented their institutions experience with anterior prostate cancer lesions in AA-men. The objective of this study was to compare the rates and grade of anterior prostate lesions in AA and non-AA men without an existing diagnosis of prostate cancer.

The authors identified 463 men without a prior diagnosis of prostate cancer (n=64 AA, n=399 non-AA) who underwent prostate biopsy following mpMRI over a 3-year period. mpMRI was used to identify lesions suspicious for prostate cancer using a 3-Tesla MRI and Invivo software system for fusion. Statistical significance of differences by race were tested with Student t-tests for means, Wilcoxon rank-sum tests for medians, Cochran-Armitage trend tests for lesion counts, and chi-square or Fisher’s exact test for nominal variables. 

In patients without a prior diagnosis of prostate cancer, there was no difference in age or gland volume between the two cohorts. However median PSA (7.9 vs. 6.3; p<0.001) and PSA density (PSAD) (0.134 vs 0.111; p<0.03) were higher in AA men. The two cohorts were found to harbor anterior prostate lesions at a similar rate (AA men: 15/64, 23.4%; non-AA men: 112/399, 28.1%; p=0.37). Additionally, AA men were not more likely to have a Gleason ≥7 from an anterior prostate lesion (AA men: 4/15, 26.7%; non-AA men: 28/112, 25%, p=0.89) or be diagnosed Gleason ≥7 prostate cancer overall (AA men: 11/64, 17.2%; non-AA men: 74/399, 18.5%; p=0.79). 
In contrast to prior studies, among men without a previous diagnosis of prostate cancer, AA men were not found to have increased rates of anterior prostate lesions or more Gleason ≥7 in these lesions compared to a non-AA cohort. Furthermore, despite higher PSA and PSAD, AA men were equally likely to be diagnosed with Gleason ≥7 prostate cancer overall.

References:

1. Kongnyuy M, Sidana A, George AK, et al. The significance of anterior prostate lesions on multiparametric magnetic resonance imaging in African-American men. Urol Oncol 2016;34(6):254.e15-21.


Presented by: Gopal Nand Gupta, MD

Co-Authors: Michelle Van Kuiken MD¹, Bryan Bisanz BS¹, Cara Joyce PhD¹, Marcus Quek MD¹ and Gopal Gupta MD²

Affiliations: ¹Loyola Univeristy Medical Center; ²Loyola University Medical Center, Maywood, IL

Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DCbr />