Not so black and white.

In 2016, the landmark UK ProtecT trial reported no difference in cancer-specific mortality rates at 10 years among men with PSA-detected clinically-localized prostate cancer randomized to active surveillance or treatment—with those mortality rates being a whopping 1% across the board. Pretty much everyone ignores that 2% of the over 1600 enrolled would be high-risk by today’s criteria, and lots of people refute the evidence even for the 21% of enrollees with intermediate-risk disease. Because, hey, these guys have bad biology. A recent JAMA viewpoint asks how comfortable we should feel, then, offering active surveillance to our black patients who represented a measly 1% of ProtecT enrollees? TBL: Black patients have distinct prostate cancer biology and lack good data supporting safe active surveillance.