Despite Presenting With More Aggressive Disease, Black Vs White Men With Prostate Cancer Have Improved Outcomes Following Radiotherapy

Although Black patients with localized prostate cancer tend to present with more aggressive disease, they have better outcomes following definitive radiotherapy compared with White patients, according to findings from a meta-analysis published in JAMA Network Open.1 Investigators wrote that other determinants of outcome including access to care could be important factors towards achieving racial equity in the prostate cancer space.¹

Prior to adjustment, Black patients were less likely to experience biochemical recurrence (BCR; subdistribution HR [sHR], 0.88; 95% CI, 0.58-0.91), distant metastases (sHR, 0.72; 95% CI, 0.58-0.91), or prostate cancer-specific mortality (PCSM; sHR 0.72; 95% CI, 0.54-0.97) compared with White patients. When the rates were adjusted, Black race was still significantly associated with improved BCR (adjusted sHR, 0.79; 95% CI, 0.72-0.88; P <.001), distant metastases (adjusted sHR, 0.69; 95% CI, 0.55-0.87; P = .002), and PCSM (adjusted sHR, 0.68; 95% CI, 0.50-0.93; P = .01).

“These results provide high-level evidence challenging the common belief that Black men who are diagnosed with prostate cancer will necessarily have a worse prognosis than White men. This is especially important because an unfounded belief can inadvertently contribute to cancer injustice, leading to the use of more aggressive treatments than might be necessary—potentially reducing the quality of life—and diverting attention away from other important factors that can influence the outcome, including access to more comprehensive healthcare,” Amar U. Kishan, MD, associate professor and vice chair of Clinical and Translational Research and chief of the Genitourinary Oncology Service for the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA and the UCLA Jonsson Comprehensive Cancer Center, said in a press release.²

A total of 8814 patients were identified for the analysis, of whom 18.5% were Black and 81.5% were White. The median age was 69.1 years, and 19.8% of patients were low risk, 48.4% were intermediate risk, and 31.8% were high-risk. The median follow-up was 10.6 years.

When looking at patient characteristics, Black patients were more likely to be younger (68 years vs 71 years; P <.001), present with higher-risk disease (38.2% vs 30.4%; P <.001), have higher prostate-specific antigen levels (10.3 vs 8.4; P <.001), and have Gleason scores between 8 and 10 (16.3% vs 14.1%; P = .03) compared with White patients. No difference was observed with regard to ct3/4 disease between patient populations (17.0% vs 18.7%; P = .10), but patients who were Black were more likely to have cT1 disease (50.5% vs 41.3%; P <.001).

The unadjusted 10-year cumulative incidence rate was lower in Black patients for BCR (40.5% vs 44.6%; P = .006), distant metastases (8.4% vs 11.6%; P = .005), and PCSM (4.5% vs 6.4%; P = .03). All-cause mortality or distant metastases at 10-years were similar, with all-cause mortality rate of 39.8% in Black patients vs 41.2% in White patients (log-rank test P = .43), and the distant metastases rates were 41.5% vs 43.6% (log-rank test P = .40). Additionally, other cause mortality at 10-years was similar at 37.2% in Black patients vs 36.6% in White patients (P = .50).

There was a lower percentage of mortality events related to PCSM (6.5%) than other cause mortality (10.2%) and in patients younger than 65 years (7.6% vs 14.9%), those older than 65 years (6.0% vs 9.2%), and in those with high-risk disease (6.4% vs 12.7%).

Patients did not experience a significant difference in all-cause mortality (HR, 0.99; 95% CI, 0.92-1.07; P = .87), time to other cause mortality (sHR, 1.03; 95% CI, 0.95-1.12; P = .50), and distant metastases or death (HR, 1.00; 95% CI, 0.92-1.08; P = .91).

References

1. Ma TM, Romero T, Nickols NG, et al. Comparison of response to definitive radiotherapy for localized prostate cancer in black and white men: a meta-analysis. JAMA Netw Open. Published December 1, 2021. doi:10.1001/jamanetworkopen.2021.39769
2. Study: Although they tend to be diagnosed with higher-risk prostate cancer, Black men undergoing radiation therapy have better outcomes than white men. News Release. UCLA Health. December 29, 2021. Accessed September 21, 2022. https://bit.ly/3BSWxeP