Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Model risk scores may underestimate rate of biochemical recurrence in African American men with localized prostate cancer: a cohort analysis of over 3000 men

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Introduction

This study aims to determine if there is a difference in prostate cancer nomogram-adjusted risk of biochemical recurrence (BCR) and/or adverse pathology (AP) between African American (AAM) and Caucasian men (CM) undergoing radical prostatectomy (RP).

Methods

A retrospective review was performed of men undergoing RP in the Pennsylvania Urologic Regional Collaborative between 2015 and 2021. Cox proportional hazard regression models were used to compare the rate of BCR after RP, and logistic regression models were used to compare rates of AP after RP between CM and AAM, adjusting for the CAPRA, CAPRA-S, and MSKCC pre- and post-operative nomogram scores.

Results

Rates of BCR and AP after RP were analyzed from 3190 and 5029 men meeting inclusion criteria, respectively. The 2-year BCR-free survival was lower in AAM (72.5%) compared to CM (79.0%), with a hazard ratio (HR) of 1.38 (95% CI 1.16–1.63, p < 0.001). The rate of BCR was significantly greater in AAM compared to CM after adjustment for MSKCC pre-op (HR 1.29; 95% CI 1.08–1.53; p = 0.004), and post-op nomograms (HR 1.26; 95% CI 1.05–1.49; p < 0.001). There was a trend toward higher BCR rates among AAM after adjustment for CAPRA (HR 1.13; 95% CI 0.95–1.35; p = 0.17) and CAPRA-S nomograms (HR 1.11; 95% 0.93–1.32; p = 0.25), which did not reach statistical significance. The rate of AP was significantly greater in AAM compared to CM after adjusting for CAPRA (OR 1.28; 95% CI 1.10–1.50; p = 0.001) and MSKCC nomograms (OR 1.23; 95% CI 1.06–1.43; p = 0.007).

Conclusion

This analysis of a large multicenter cohort provides further evidence that AAM may have higher rates of BCR and AP after RP than is predicted by CAPRA and MSKCC nomograms. Accordingly, AAM may benefit with closer post-operative surveillance and may be more likely to require salvage therapies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart depicting patient selection for study inclusion.
Fig. 2: Kaplan–Meier curves demonstrating biochemical recurrence rates after radical prostatectomy stratified by race.
Fig. 3: Forest plot comparing biochemical recurrence rates between African American and Caucasian men adjusted by nomogram risk model.
Fig. 4: Forest plot comparing adverse pathology rates between African American and Caucasian men adjusted by nomogram risk model.

Similar content being viewed by others

Data availability

The data that support the findings of this study are available on request from the Pennsylvania Urologic Regional Collaborative (PURC). The data are not publicly available due to institutional and patient privacy concerns.

References

  1. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2018;199:683–90.

    Article  PubMed  Google Scholar 

  2. Gershman B, Maroni P, Tilburt JC, Volk RJ, Konety B, Bennett CL, et al. A national survey of radiation oncologists and urologists on prediction tools and nomograms for localized prostate cancer. World J Urol. 2019;37:2099–108.

    Article  PubMed  Google Scholar 

  3. Bauer JJ, Connelly RR, Seterhenn IA, Deausen J, Srivastava S, Mcleod DG, et al. Biostatistical modeling using traditional preoperative and pathological prognostic variables in the selection of men at high risk for disease recurrence after radical prostatectomy for prostate cancer. J Urol. 1998;159:929–33.

    Article  CAS  PubMed  Google Scholar 

  4. Moul JW, Connelly RR, Lubeck DP, Bauer JJ, Sun L, Flanders SC, et al. Predicting risk of prostate specific antigen recurrence after radical prostatectomy with the Center for Prostate Disease Research and Cancer of the Prostate Strategic Urologic Research Endeavor databases. J Urol. 2001;166:1322–7.

    Article  CAS  PubMed  Google Scholar 

  5. Schroeck FR, Sun L, Freedland SJ, Jayachandran J, Robertson CN, Moul JW. Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy. Prostate Cancer Prostatic Dis. 2008;11:371–6.

    Article  CAS  PubMed  Google Scholar 

  6. Hamilton RJ, Aronson WJ, Presti JC Jr, Terris MK, Kane CJ, Amling CL, et al. Race, biochemical disease recurrence, and prostate–specific antigen doubling time after radical prostatectomy: results from the SEARCH database. Cancer. 2007;110:2202–9.

    Article  CAS  PubMed  Google Scholar 

  7. Nielsen ME, Han M, Mangold L, Humphreys E, Walsh PC, Partin AW, et al. Black race does not independently predict adverse outcome following radical retropubic prostatectomy at a tertiary referral center. J Urol. 2006;176:515–9.

    Article  PubMed  Google Scholar 

  8. Cooperberg MR, Pasta DJ, Elkin EP, Litwin MS, Latini DM, Du Chane J, et al. The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol. 2005;173:1938–42.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kattan MW, Eastham JA, Stapleton AM, Wheeler TM, Scardino PT. A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst. 1998;90:766–71.

    Article  CAS  PubMed  Google Scholar 

  10. Cooperberg MR, Hilton JF, Carroll PR. The CAPRA‐S score: a straightforward tool for improved prediction of outcomes after radical prostatectomy. Cancer. 2011;117:5039–46.

    Article  PubMed  Google Scholar 

  11. Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol. 1999;17:1499.

    Article  CAS  PubMed  Google Scholar 

  12. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969–74.

    Article  PubMed  Google Scholar 

  13. Moreira DM, Presti JC, Aronson WJ, Terris MK, Kane CJ, Amling CL, et al. The effect of race on the discriminatory accuracy of models to predict biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases. Prostate Cancer Prostatic Dis. 2010;13:87–93.

    Article  CAS  PubMed  Google Scholar 

  14. Bianco FJ Jr, Kattan MW, Scardino PT, Powell IJ, Pontes JE, Wood DP Jr. Radical prostatectomy nomograms in black American men: accuracy and applicability. J Urol. 2003;170:73–77.

    Article  PubMed  Google Scholar 

  15. Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Vol. 608. New York: Springer; 2001.

  16. Berg S, Tully KH, Sahraoui A, Tan WS, Krimphove MJ, Marchese M, et al. Inequity in selective referral to high-volume hospitals for genitourinary malignancies. Urol Oncol. 2020;38:582–9.

    Article  Google Scholar 

  17. Park MY, Park KJ, Kim MH, Kim JK. Preoperative MRI-based estimation of risk for positive resection margin after radical prostatectomy in patients with prostate cancer: development and validation of a simple scoring system. Eur Radiol. 2021;31:4898–907.

    Article  PubMed  Google Scholar 

  18. Bernstein AN, Talwar R, Handorf E, Syed K, Danella J, Ginzburg S, et al. Assessment of prostate cancer treatment among black and white patients during the COVID-19 pandemic. JAMA Oncol. 2021;7:1467–73.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

    Matthew Epstein & Adam C. Reese

  2. Health Care Improvement Foundation, Philadelphia, PA, USA

    Kaynaat Syed

  3. Geisinger Health System, Danville, PA, USA

    John Danella

  4. Einstein Healthcare Network, Philadelphia, PA, USA

    Serge Ginzburg

  5. MidLantic Urology/Main Line Health, Bala Cynwyd, PA, USA

    Laurence Belkoff

  6. Cooper University Health Care, Camden, NJ, USA

    Jeffrey Tomaszewski

  7. Thomas Jefferson University, Philadelphia, PA, USA

    Edouard Trabulsi

  8. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Eric A. Singer

  9. University of Pittsburgh, Pittsburgh, PA, USA

    Bruce L. Jacobs

  10. Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

    Jay D. Raman

  11. University of Pennsylvania, Philadelphia, PA, USA

    Thomas J. Guzzo

  12. Fox Chase Cancer Center, Philadelphia, PA, USA

    Robert Uzzo

Authors
  1. Matthew Epstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaynaat Syed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Danella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Serge Ginzburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laurence Belkoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeffrey Tomaszewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edouard Trabulsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eric A. Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bruce L. Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jay D. Raman
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas J. Guzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert Uzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Adam C. Reese
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: ME, ACR. Methodology, statistical analysis, and writing: ME. Data acquisition: KS. Review and editing: JD, SG, LB, JT, ET, EAS, BJ, JDR, TG, RU, ACR. Supervision: ACR.

Corresponding author

Correspondence to Adam C. Reese.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Epstein, M., Syed, K., Danella, J. et al. Model risk scores may underestimate rate of biochemical recurrence in African American men with localized prostate cancer: a cohort analysis of over 3000 men. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00727-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41391-023-00727-6

This article is cited by

Search

Advanced search

Quick links