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The impact of race/ethnicity on upstaging and/or upgrading rates among intermediate risk prostate cancer patients treated with radical prostatectomy

Abstract

Background

Race/ethnicity may predispose to less favorable prostate cancer characteristics in intermediate risk prostate cancer (IR PCa) patients. We tested this hypothesis in a subgroup of IR PCa patients treated with radical prostatectomy (RP).

Methods

We relied on the Surveillance, Epidemiology and End Results 2004–2016. The effect of race/ethnicity was tested in univariable and multivariable logistic regression analyses predicting upstaging (pT3+/pN1) and/or upgrading (Gleason Grade Group [GGG] 4–5) at RP.

Results

Of 20,391 IR PCa patients, 15,050 (73.8%) were Caucasian, 2857 (14.0%) African-American, 1632 (8.0%) Hispanic/Latino and 852 (4.2%) Asian. Asian patients exhibited highest age (64 year), highest PSA (6.8 ng/ml) and highest rate of GGG3 (31.9%). African-Americans exhibited the highest percentage of positive cores at biopsy (41.7%) and the highest proportion of NCCN unfavorable risk group membership (54.6%). Conversely, Caucasians exhibited the highest proportion of cT2 stage (35.6%). In univariable analyses, Hispanic/Latinos exhibited the highest rates of upstaging/upgrading among all race/ethnicities, in both favorable and unfavorable groups, followed by Asians, Caucasians and African-Americans in that order. In multivariable analyses, Hispanic/Latino race/ethnicity represented an independent predictor of higher upstaging and/or upgrading in favorable IR PCa (odds ratio [OR] 1.27, p < 0.01), while African-American race/ethnicity represented an independent predictor of lower upstaging and/or upgrading in unfavorable IR PCa (OR 0.79, p < 0.001).

Conclusion

Race/ethnicity predisposes to differences in clinical, as well as in pathological characteristics in IR PCa patients. Specifically, even after full statistical adjustment, Hispanic/Latinos are at higher and African-Americans are at lower risk of upstaging and/or upgrading.

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Authors

Contributions

LN: Conception and design, acquisition of data, analysis and interpretation of data, statistical analyses, drafting of manuscript. MW: Acquisition of data, critical revision of the manuscript, analysis and interpretation of data. CCR: Acquisition of data, critical revision of the manuscript, analysis and interpretation of data. CW: Acquisition of data, critical revision of the manuscript, analysis and interpretation of data. ZT: Statistical analyses. GG: Critical revision of the manuscript. NF: Critical revision of the manuscript. FKHC: Critical revision of the manuscript. VM: Critical revision of the manuscript. MG: Critical revision of the manuscript. FS: Critical revision of the manuscript. SFS: Critical revision of the manuscript. FM: Critical revision of the manuscript, supervision. AB: Critical revision of the manuscript, supervision. PIK: Conception and design, analysis and interpretation of data, drafting of the manuscript, supervision.

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Correspondence to Luigi Nocera.

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Nocera, L., Wenzel, M., Collà Ruvolo, C. et al. The impact of race/ethnicity on upstaging and/or upgrading rates among intermediate risk prostate cancer patients treated with radical prostatectomy. World J Urol (2021). https://doi.org/10.1007/s00345-021-03816-0

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Keywords

  • PCa
  • SEER
  • African-American
  • Asian
  • Hispanic/Latino