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Presentation, follow-up, and outcomes among African/Afro-Caribbean men on active surveillance for prostate cancer: experiences of a high-volume UK centre

Prostate Cancer and Prostatic Diseases volume 24, pages 549–557 (2021)Cite this article

Subjects

Abstract

Background

Experiences of African/Afro-Caribbean men on active surveillance (AS) for prostate cancer (PCa) in the United Kingdom (UK) are not well documented. We compared follow-up appointments, adherence, and clinical outcomes among African/Afro-Caribbean men on AS at a high-volume UK hospital with other ethnicities.

Methods

Men with confirmed low-intermediate risk Pca who attended the AS clinic (2005–2016) and had undergone ≥1 follow-up biopsy (n = 458) were included. Non-adherence (defined as >20% missed appointments), suspicion of disease progression (any upgrading, >30% positive cores, cT-stage > 3, PIRADS > 3), any upgrading from diagnostic biopsy and conversion to active treatment (prostatectomy, radiotherapy or hormone therapy) according to ethnicity (African/Afro-Caribbean versus other ethnicities) were assessed using multivariable regression analysis.

Results

Twenty-three percent of eligible men were recorded as African/Afro-Caribbean, while the remainder were predominantly Caucasian. African/Afro-Caribbean men had slightly lower PSA at diagnosis (median 5.0 vs. 6.0 ng/mL) and more positive cores at diagnosis (median 2 vs. 1). They had a substantially higher rate of non-attendance at scheduled follow-up visits (24% vs. 10%, p < 0.001). Adjusted analyses suggest African/Afro-Caribbean men may be at increased risk of disease progression (hazard ratio [HR]: 1.38; 95% confidence interval [CI] 0.99–1.91, P = 0.054) and upgrading (HR: 1.29; 95% CI 0.87–1.92, P = 0.305), though neither reached statistical significance. No difference in risk of conversion to treatment was observed between ethnic groups (HR: 1.03; 95% CI 0.64–1.47, P = 0.873).

Conclusions

African/Afro-Caribbean men on AS for PCa in the UK are less likely to adhere to scheduled appointments, suggesting a more tailored service addressing their specific needs may be required. While African/Afro-Caribbean men were no more likely to convert to treatment than Caucasian/other men, findings of a potentially higher risk of disease progression signal the need for careful selection and monitoring of African/Afro-Caribbean men on AS. Larger prospective, multicentre studies with longer follow-up are required to provide more definitive conclusions.

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Fig. 1: Kaplan–Meier curves among men on AS who had undergone one or more follow-up biopsy.

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Acknowledgements

The authors thank Milad Golsharifi, Hannah Yonis, and Anisah Khan for their assistance in collecting and collating the data used in this study.

Funding

KB was supported by an NHMRC Early Career Research Fellowship (GNT1124210).

Author information

Author notes

  1. These authors contributed equally: Francesca Kum, Kerri Beckmann

Authors and Affiliations

  1. Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Francesca Kum, Haleema Aya, Jonah Rusere, Grace Zisengwe, Paul Cathcart, Ben Challacombe, Christian Brown, Rick Popert, Prokar Dasgupta & Oussama Elhage

  2. Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Francesca Kum, Haleema Aya, Sohail Singh, Preeti Sandhu, Sukhmani Sra & Ben Challacombe

  3. Cancer Research Institute, University of South Australia, Adelaide, SA, Australia

    Kerri Beckmann

  4. Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK

    Kerri Beckmann, Aida Santaolalla & Mieke Van Hemelrijck

  5. School of Immunology and Microbial Sciences, Kings College London, London, UK

    Prokar Dasgupta & Oussama Elhage

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Correspondence to Kerri Beckmann.

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Kum, F., Beckmann, K., Aya, H. et al. Presentation, follow-up, and outcomes among African/Afro-Caribbean men on active surveillance for prostate cancer: experiences of a high-volume UK centre. Prostate Cancer Prostatic Dis 24, 549–557 (2021). https://doi.org/10.1038/s41391-020-00313-0

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