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Prostate cancer in African Americans: Early oncological and functional outcomes after robotic prostatectomy

DOI: 10.1111/iju.13255 Racial differences in prostate cancer stage and treatment have been documented before. African American men have been shown to harbor more aggressive prostate carcinoma at relatively younger ages, and are more likely to undergo radiation as opposed to surgery. Racial disparities in oncological outcomes after prostate cancer treatment have been shown in previous studies. This report compares the functional and immediate oncological outcome of RALP among African American and white men in a single-surgeon patient database. After institutional review board approval (IRB no. 13-642A), a database of single-surgeon patients undergoing RALP was analyzed. The database was searched for patients with available data for urinary continence, potency and biochemical recurrence at 12 months after surgery. Potency was defined as a Sexual Health Inventory for Men (SHIM) score ≥17 or as a categorical variable indicating erection firm enough for intercourse. Urinary continence was defined as using no pad or one security pad. Biochemical recurrence was defined as PSA level >0.2 ng/mL 6 weeks after surgery. To further compare the outcomes of RALP in African American men with white men, a propensity scoring matching was carried out with a 1:5 ratio. Demographic and clinical characteristics were used in a matching process. The total study population for analysis was 2180 patients. African American men were younger than white men (P < 0.001), with a mean age of 56.9 years (40–79 years) and 60.1 years (32–74 years). There was no difference in family history, PSA level, clinical stage, biopsy cores and Gleason score. African American and white men had similar general health status assessed by the ASA classification, and preoperative continence, potency and IPSS score. In pathological evaluation, the mean prostate weight was not different between African American (51.8 19.2) and white men (51.6 23.3; P = 0.84). The index tumor was larger in African American men; however, it did not reach statistical significance (P = 0.05). African American men had higher tumor volume (P = 0.01), and the margin status was similar between African American and white men. Gleason scoring was distributed differently. African American men had more Gleason 3 + 4 and Gleason 4 + 3, whereas Gleason 6 and Gleason ≥8 was more common in white men. The upgrading rate was similar between African American (35.0%) and white men (36.1%; P = 0.26). The majority of patients in the study had pT2 disease. Surgical data including operative time, neurovascular sparing and blood loss were similar between African American and white men. At 12 months after surgery, African American and white men had similar urinary continence rates of 84% and 83.8% (P = 0.93), respectively. Potency was higher in white men (82.2% vs 76.1%), but not statistically significant (P = 0.35). African American men had fewer lower urinary tract symptoms compared with white men (P = 0.03). The biochemical recurrence rate was similar in African American and white men, 5.9% and 6.8% (P = 0.59), respectively. During the match process, 920 white men were matched for 184 African American men. In the pathological evaluation after the matching process, the difference in Gleason scoring was not statistically different (P = 0.06; Table 1). In follow-up data, however, the difference in potency at 12 months after surgery was statistically significant (P = 0.01). African American men gained potency in 71.1% compared with 87.0% white men. Although the continence rate was not different at 12 months after surgery, African American men after match had higher scores in IPSS, a finding in contrast to primary results before the matching process (Table 1). White men had mild lower urinary tract symptoms in 65.0% compared with 51.7% of African American men (P < 0.01). The biochemical recurrence rate was similar in African American (5.1%) and white men (7.5%) after the matching process (P = 0.25). Return of sexual function after prostate cancer treatment is complicated. The patient definition of sexual function differs between ethnic groups, as well as satisfaction of sexual function. Socioeconomic status is shown to impact the outcome after prostate cancer treatment. Different health-seeking patterns can also affect the outcome after RALP. Considering these confounding factors, the difference in sexual function outcome should be interpreted with caution. The immediate oncological outcome of RALP was similar between African American and white men. The urinary continence rate was similar in both populations, but white men had