In the United Kingdom, where the National Health Service (NHS) allows for equal healthcare access, Black men and White men with metastatic castration-resistant prostate cancer (mCRPC) have similar overall survival, according to a recent study.
Black men, however, have significantly better survival among patients who receive only hormone-based therapy throughout their treatment course.
“As the first European study to our knowledge exploring differences in outcome based on race, it contributes to the ongoing discussion about the relative influence of socioeconomics and pharmacogenomics on racial disparity in prostate cancer outcomes,” a team led by Jonathan Shamash, MD, of Barts Health NHS Trust in London, UK, reported in Prostate Cancer and Prostatic Diseases.
Prostate cancer in Black men is associated with worse outcomes compared with their White counterparts, Dr Shamash and colleagues noted, but most studies demonstrating this disparity involved localized tumors and were conducted primarily in the United States.
In a study of 425 patients with mCRPC treated at St. Bartholomew’s Hospital in East London from 1997 to 2016, Dr Shamash’s team found that the median overall survival was 25.5 months for Black men and 21.8 months for White men, a nonsignificant difference, according to the investigators. In a subgroup of patients who received hormone-based therapy exclusively, median survival times were significantly longer for Black than White men (39.7 vs 17.1 months), with Black men benefiting from a significant 46% decreased risk for death compared with White men. The survival difference is unlikely to be related to baseline patient characteristics, the investigators stated.
Dr Shamash and colleagues acknowledged that the treatment landscape of mCRPC has changed with the introduction of novel antiandrogen agents, and that their study cohort included only 9 patients who received these agents from 1997 to 2016. Abireratone and enzalutamide only received marketing approved in the United Kingdom in 2016. As a result, they examined outcomes in a separate and more contemporary cohort (with an August 2019 cutoff date for data analysis) of 134 men with mCRPC who had received enzalutamide. They found no difference in overall survival based on ethnicity.
Dr Shamash and colleagues concluded that Black men with mCRPC “do not do worse” than White men. “In making this conclusion, we appreciate that ethnicity is a complex entity, and that any proposed relationship between ethnicity, social class, educational level, and other determinants of health can never be fully adjusted for.”
Ng K, Wilson P, Mutsvangwa K, Hounsome L, Shamash J. Overall survival of black and white men with metastatic castration-resistant prostate cancer (mCRPC): a 20-year retrospective analysis in the largest healthcare trust in England. Published online January 21, 2021. Prostate Cancer Prostatic Dis. doi:10.1038/s41391-020-00316-x