Significant Change in Predicted Risk of Biochemical Recurrence After Radical Prostatectomy More Common in Black Than in White Men - 06/08/11

Doi : 10.1016/j.urology.2008.10.075

Melissa A. Laudano ^a,⁎ , Ketan K. Badani ^a, Tara R. McCann ^a, Mark J. Mann ^a, Chad Ritch ^a, Manisha Desai ^b, Mitchell C. Benson ^a, James M. McKiernan ^a
^a Department of Urology, Columbia University Medical Center, New York, New York
^b Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York

^*Reprint requests: Melissa Laudano, B.S., Department of Urology, Columbia University Medical Center, 100 Haven Avenue, Apt 23D, New York, NY 10032

Résumé

Objectives

To examine by race how frequently the data after radical prostatectomy translates into a substantial change in prognosis. Many nomograms exist to predict the survival outcomes using the pretreatment clinical parameters and post-treatment pathologic parameters. Race might be an important factor affecting their predictive ability.

Methods

Kattan nomograms were used to calculate the pretreatment and post-radical prostatectomy 5-year progression-free probability for each patient. The difference between the nomogram scores was used to divide the patients into 3 groups. A decrease in probability of ≥15 percentage points was classified as a significant increase in the probability of recurrence, an increase of ≥15 points was classified as a significant decrease in the probability of recurrence, and an absolute change of <15 points was considered no significant change.

Results

The data from 1709 (132 black and 1577 white) men were analyzed. Among the black men, 26.5% had an increase in the probability of recurrence, 57.6% had no change, and 15.9% had a decrease in the probability of recurrence. Among the white men, 13.8% had an increase in the probability of recurrence, 64.5% had no change, and 21.7% had a decrease in the probability of recurrence. Black men were twice as likely to have a significant increase in the probability of recurrence postoperatively compared with white men after adjusting for preoperative prostate-specific antigen level, clinical stage, and biopsy Gleason sum (odds ratio 2.0, 95% confidence interval 1.3-3.1, P = .002).