Misclassification of Gleason grade and tumor stage in Asian-American patients with low-risk prostate cancer

Purpose: To investigate the misclassification rates of Asian-American patients with low-risk prostate cancer (PCa). Methods: : Patients diagnosed with low-risk PCa treated with radical prostatectomy (RP) between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Then, basic characteristics and pathological outcomes of the enrolled patients were retrospectively extracted. We compared the rates of upgrading and/or upstaging between Asian-American patients and White/Black patients. Moreover, temporal trend analyses were performed to explore the changes in upgrading and upstaging rates in each race over time. Finally, logistic regression models were constructed to explore the role of Asian race in upgrading and upstaging and to screen out potential risk factors for predicting upgrading and upstaging in Asian-American patients. Results: : Asian-Americans had a significantly higher rate of upgrading than Whites (P<0.001), while no statistical difference was found in the comparison of upstaging rate (P=0.536). Moreover, Asian-Americans were more likely to upgrade to diseases with higher International Society of Urological Pathology (ISUP) grade than Whites (P=0.010). The rate of upgrading increased significantly over time in White and Black patients, but not in Asian-American patients. Finally, race seemed to be an independent risk factor for predicting upgrading, while the racial differences seemed to be more pronounced between White and Black patients. Conclusion: Asian-American patients had a significantly higher rate of upgrading than White patients. Moreover, Asian-American patients were more likely to upgrade to diseases with higher ISUP grade. Further risk assessment before clinical decision for low-risk PCa patients with the help of significant clinical variables is required.