Proportion of Gleason Score ≥8 Prostate Cancer on Biopsy and Tumor Aggressiveness in Matched Cohorts of East Asian and Non-East Asian Men

Liang Dong,Katherine Lajkosz，Wei Xue,Alexandre R. Zlotta

JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK（2024）

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Abstract

Background:Historically, Asia had a lower prostate cancer (PCa) incidence and mortality compared with Western countries, but the gap isnarrowing. Paradoxically, Asians have been reported to present with more advanced disease though more favorable outcomes. DespitePCa becoming an emerging health priority in East Asia, our knowledge remains limited. We compared the prevalence of high-grade PCaon biopsy and disease progression after radical prostatectomy (RP) in East Asian men from Asia and non-East Asian men from Westerncountries.Methods:This retrospective cohort study included men who underwent prostate biopsy and RP at academic centers in Shanghai,China, and Toronto, Canada (2014-2019). The expanded RP cohort included East Asian men from Singapore (n5282) and non-East Asiansfrom Paris (n5192). Primary endpoints included the proportion of men with Gleason score (GS)$8 on biopsy and metastasis-free survival(MFS) after RP for GS$8. Multivariable logistic regression and Cox proportional hazard models were performed. Propensity score matchingwas used to reduce imbalances between cohorts.Results:PCa was found on biopsy in 2,343 of 4,905 (48%) East Asians and 2,317 of 3,482(67%) non-East Asians (P,.001). Prostate-specific antigen (PSA) levels at presentation and the proportion of men with GS$8werehigherinEast Asians than non-East Asians (12.4 vs 6.6 ng/mL and 15.0% vs 8.8%, respectively; bothP,.001). On multivariable analysis, there wasno difference in the proportion of men with GS$8 between matched cohorts with PSA,20 ng/mL (n53,572; odds ratio, 1.05 [95% CI,0.77-1.43];P5.76). No difference in MFS was found after RP between matched cohorts (hazard ratio, 0.97 [95% CI, 0.55-1.70];P5.92).Conclusions:This contemporary study demonstrates that East Asian men are equally as likely to harbor aggressive PCa on biopsy as non-East Asian men at PSA levels observed in screening programs, with no difference in disease aggressiveness after RP. The assumption thatunfavorable PCa at diagnosis is more common but less aggressive in East Asians should be revisited and viewed in the context of the ex-pected increase in the PCa burden worldwide

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【要点】：本研究通过比较东亚和非东亚男性在活检中 Gleason 评分 ≥8 的前列腺癌比例及根治性前列腺切除术后疾病进展情况，发现东亚男性在筛查中观察到的前列腺特异性抗原（PSA）水平较高时，其患有侵袭性前列腺癌的风险与非东亚男性相当，且术后疾病侵袭性无差异。

【方法】：采用回顾性队列研究方法，收集了中国上海和加拿大 Toronto 学术中心在 2014-2019 年间接受前列腺活检和根治性前列腺切除术的男性患者数据，并扩展至新加坡和巴黎的队列。

【实验】：研究中比较了 4,905 名东亚患者和 3,482 名非东亚患者在活检中发现前列腺癌的比例，以及 2,874 名东亚患者和 1,964 名非东亚患者在根治性前列腺切除术后无转移生存期（MFS）。通过多变量逻辑回归和Cox比例风险模型进行分析，并使用倾向得分匹配减少队列间的失衡。结果显示，东亚患者在活检中发现前列腺癌的比例低于非东亚患者（48% vs 67%），但在 PSA 水平 ≥20 ng/mL 时，两组患者在活检中患有 Gleason 评分 ≥8 前列腺癌的比例无差异，且根治性前列腺切除术后两组患者的无转移生存期无差异。