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

Authors:
Liang Dong Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Katherine Lajkosz Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

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Rafael Sanchez-Salas Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada

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Cynthia Kuk Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada

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Wei Xu Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

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Raj Vikesh Tiwari Department of Urology, Singapore General Hospital, Singapore
Department of Urology, Sengkang General Hospital, Singapore

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Caio Pasquali Dias dos Santos Department of Urology, L‘Institut Mutualiste Montsouris, Paris, France

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Hongyang Qian Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Jiayi Wang Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Baijun Dong Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Jiahua Pan Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Yinjie Zhu Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Qiang Liu Department of Pathology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Amy Chan Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada

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Jethro C.C. Kwong Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Dixon T.S. Woon Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Michael Nesbitt Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Annette Erlich Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada

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Girish S. Kulkarni Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Nathan Perlis Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Robert J. Hamilton Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Laurence Klotz Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Canada

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Christopher J.D. Wallis Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada

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David-Dan Nguyen Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

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Petr Macek Department of Urology, L‘Institut Mutualiste Montsouris, Paris, France

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Kae Jack Tay Department of Urology, Singapore General Hospital, Singapore

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Honghong Huang Department of Urology, Singapore General Hospital, Singapore

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Ants Toi Department of Medical Imaging, University Health Network, Toronto, Canada

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Antonio Finelli Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Neil E. Fleshner Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

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Christopher W.S. Cheng Department of Urology, Sengkang General Hospital, Singapore

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Xavier Cathelineau Department of Urology, L‘Institut Mutualiste Montsouris, Paris, France

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Theodorus H. van der Kwast Department of Pathology, University Health Network, Toronto, Canada

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Wei Xue Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Alexandre R. Zlotta Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Canada

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Volume/Issue:
Volume 22: Issue 10
Online Publication Date:
15 Nov 2024
DOI:
https://doi.org/10.6004/jnccn.2024.7061
Restricted access

Background: Historically, Asia had a lower prostate cancer (PCa) incidence and mortality compared with Western countries, but the gap is narrowing. Paradoxically, Asians have been reported to present with more advanced disease though more favorable outcomes. Despite PCa becoming an emerging health priority in East Asia, our knowledge remains limited. We compared the prevalence of high-grade PCa on biopsy and disease progression after radical prostatectomy (RP) in East Asian men from Asia and non-East Asian men from Western countries. 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 (n=282) and non-East Asians from Paris (n=192). 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 matching was 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 ≥8 were higher in East Asians than non-East Asians (12.4 vs 6.6 ng/mL and 15.0% vs 8.8%, respectively; both P<.001). On multivariable analysis, there was no difference in the proportion of men with GS ≥8 between matched cohorts with PSA <20 ng/mL (n=3,572; odds ratio, 1.05 [95% CI, 0.77–1.43]; P=.76). No difference in MFS was found after RP between matched cohorts (hazard ratio, 0.97 [95% CI, 0.55–1.70]; P=.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 that unfavorable PCa at diagnosis is more common but less aggressive in East Asians should be revisited and viewed in the context of the expected increase in the PCa burden worldwide.

Submitted May 1, 2024; final revision received July 8, 2024; accepted for publication July 31, 2024. Published online November 15, 2024.

L. Dong and K. Lajkosz are co–first authors.

W. Xue and A.R. Zlotta are co–senior authors.

Previous presentation: Part of this work was presented at the American Urological Association 2021 Annual Meeting, September 10–13, 2021, Las Vegas, NV; Singapore Urological Association UROFAIR 2022, July 14–16, 2022, Singapore; and Society of Urologic Oncology 23rd Annual Meeting, November 30–December 1, 2022, San Diego, CA. Additionally, this work was presented at the 39th Annual European Association of Urology Congress 2024, April 5–8, 2024, Paris, France; Abstract P045.

Author contributions: Conceptualization: L. Dong, B. Dong, Pan, Woon, Xue, Zlotta. Data curation: L. Dong, Sanchez-Salas, Kuk, Tiwari, Dias dos Santos, Qian, Wang, B. Dong, Pan, Zhu, Woon, Nesbitt, Erlich, Kulkarni, Perlis, Hamilton, Macek, Tay, Huang, Toi, Finelli, Fleshner, Cheng, Cathelineau, van der Kwast, Xue, Zlotta. Formal analysis: Lajkosz, Xu. Investigation: Liu, van der Kwast, Xue, Zlotta. Methodology: L. Dong, Lajkosz, Qian, Wang, Zhu, Zlotta. Project administration: Sanchez-Salas, Kuk, Chan, Erlich, Zlotta. Supervision: Sanchez-Salas, Xu, Macek, Tay, Huang, Cheng, Cathelineau, Xue, Zlotta. Writing—original draft: Zlotta. Writing—review & editing: L. Dong, Lajkosz, Kuk, Tiwari, Chan, Kwong, Klotz, Wallis, Nguyen, Fleshner.

Data availability statement: The data underlying this article cannot be shared publicly. Even de-identified, the data cannot be shared publicly for the privacy of the individuals’ data used in the study.

Disclosures: Dr. Kulkarni has disclosed serving as a scientific advisor for AbbVie, TerSera, Knight Therapeutics, Bristol Myers Squibb, AstraZeneca, Johnson & Johnson, Merck, Ferring Pharmaceuticals, Verity Pharmaceuticals, Theralase Technologies, Photocure, Astellas Pharma, and Tolmar. Dr. Hamilton has disclosed receiving grant/research support from Janssen and Novartis; and serving as a scientific advisor for Janssen, Astella Pharma, AbbVie, TerSera, Novartis, and Knight Therapeutics. Dr. Wallis has disclosed receiving grant/research support from Knight Therapeutics, Tolmar, and Bayer; serving as a scientific advisor for Bayer, EMD Serono, Knight Therapeutics, and Tolmar; and serving on a speaker’s bureau for AbbVie, Astellas Pharma, AstraZeneca, Bayer, Knight Therapeutics, Merck, TerSera, and Tolmar Pharmaceuticals. Dr. Zlotta has disclosed serving as a scientific advisor for enGene, CG Oncology, Janssen, Verity Pharmaceuticals, Ferring Pharmaceuticals, miR Scientific, Tolmar, and Theralase Technologies; and receiving consulting fees from Janssen, Verity Pharmaceuticals, Ferring Pharmaceuticals, miR Scientific, Tolmar, and Theralase Technologies. The remaining authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Funding for this study was provided by the Sinai Health Foundation and the Princess Margaret Cancer Foundation (A.R. Zlotta); The National Natural Science Foundation of China (82072847, 82103485; L. Dong, W. Xue); and the Program of Shanghai Subject Chief Scientist (19XD1402300; W. Xue).

Disclaimer: The Sinai Health Foundation, the Princess Margaret Cancer Foundation, The National Natural Science Foundation of China, and the Program of Shanghai Subject Chief Scientist had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Correspondence: Alexandre R. Zlotta, MD, PhD, Division of Urology, Department of Surgery, Mount Sinai Hospital, 60 Murray Street, 6th Floor, Room 6004, Box 19, Toronto, ON, M5T 3L9. Email: alexandre.zlotta@sinaihealth.ca

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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
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Copyright:
Copyright © 2024 by the National Comprehensive Cancer Network 2024
Article Category:
Research Article
Received:
01 May 2024
Accepted:
31 Jul 2024
Print Publication Date:
01 Dec 2024
Online Publication Date:
15 Nov 2024

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