Sylvester Researchers Conduct First Active Surveillance Study of Prostate Cancer in Hispanic Men
A new study by prostate cancer researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine has characterized the active surveillance criteria in Hispanic men, marking the first such study in this population.
When it comes to prostate cancer, early detection saves lives. Finding an aggressive tumor early, before it has spread, can offer patients more therapeutic options. However, early detection can also raise many questions. Not every prostate cancer is deadly. In fact, many are slow-growing and may never pose a serious threat.
Over-treating a less-aggressive tumor can lead to unnecessary side effects. Undertreating an aggressive one can be fatal. The key is determining the right treatments based on the unique characteristics of each patient and their cancer.
Cancer detection often starts with a high prostate specific antigen (PSA) reading, which can indicate cancer. From there, clinicians follow up with a biopsy, imaging studies and genetic tests to gauge the cancer’s aggressiveness.
If the cancer is aggressive, treatments might include hormones, radiation and/or surgical removal of the prostate. But if the tumor poses no immediate danger, physicians often recommend active surveillance. One approach is called the Epstein active surveillance criteria, or simply active surveillance. The key word is “active,” because patients undergo regular observations by a urologist, PSA testing, biopsies, MRIs and other active measures.
“When we do active surveillance, it’s not as if we’re just sitting and waiting,” said Oleksandr Kryvenko, M.D., assistant professor of pathology and urology, and a prostate cancer expert at Sylvester. “We’re closely watching out for that prostate cancer to not cause any harm to the patient.”
Still, that doesn’t mean active surveillance cannot be improved. Physicians and researchers must determine which tumors are dangerous based on their genetics, size, location and the patients being treated. What role does ethnicity play? What about body weight?
These questions led Kryvenko and colleagues in pathology, urology and radiation oncology to conduct the first clinicopathological study addressing prostate cancer active surveillance in Hispanic men. The research was recently published in the American Journal of Surgical Pathology.
“Active surveillance is an evolving matter,” said Kryvenko. “The initial studies were done in 1994 on white men, but the population has changed. Hispanics are the nation’s largest minority and, by 2050, will represent 30 percent of the population. In the urologic clinic it’s no longer just white men.”
While previous studies have investigated how active surveillance should be adjusted for African American men, this is the first time the issue has been studied in Hispanics.
The study found active surveillance criteria work reasonably well in Hispanic men and were reliable in roughly 65 percent of cases. By comparison, the criteria have been found reliable for approximately 75 percent of white non-Hispanic men and for less than 50 percent of African Americans.
But there were distinct differences that must be taken into account. For example, current biopsy protocols recommend sampling the posterior side of the prostate. However, Kryvenko’s team found aggressive tumors may be on the anterior side in the Hispanic group, meaning biopsy protocols may need to be revisited. In addition, body weight plays a role, with obese men showing lower PSA concentrations.
These findings will be combined with other research to carefully calculate how active surveillance criteria should be applied based on ethnicity, body weight and other factors. The ongoing research will help clinicians determine which patients are the best candidates for active surveillance, ensuring each person gets the appropriate approach to their disease.
“We don’t want to subject patients to the side effects associated with radiation, prostatectomy or hormone therapy if we can reliably assess the risk and identify cancer not dangerous to the patient,” said Kryvenko. “The outcomes are excellent for men who go on active surveillance, even if they need treatment later in the course of their disease.”