Black men with high-risk prostate cancer (PCa) have better oncologic outcomes following definitive radiation treatment (RT) with androgen deprivation therapy (ADT) compared with White men, according to the findings of a meta-analysis presented at the American Society for Radiation Oncology (ASTRO) virtual annual meeting.
“This work is important as it provides high-level evidence that Black men receiving standard of care treatment for localized prostate cancer have at least the same, and potentially better, response to treatment when compared with White men with similar disease features,” said lead investigator Amar U. Kishan, MD, chief of the genitourinary oncology service at the University of California, Los Angeles. “This underscores that the worse outcomes seen in population-based registries are likely due to reduced access to care and structural/systemic limitations, rather than an inherent biological resistance to treatment. This can limit therapeutic nihilism and overtreatment.”
Dr Kishan and his collaborators conducted a meta-analysis of 8 randomized trials that included 9259 men in all. The study population included 7585 White (81.9%) and 1674 Black (18.1%) men. Black men were more likely than White men to have high-risk PCa as defined by National Comprehensive Cancer Network criteria (39.2% vs 33%).
Among patients with high-risk PCa, Black men had significantly lower rates of biochemical recurrence (BCR, 46.1% vs 50.4%), distant metastasis (DM, 14% vs 21.6%), and PCa-specific mortality (PCSM, 4.9% vs 9.8%), Dr Kishan’s team reported. Among men who received radiotherapy plus short-term ADT, Black men had a significant 27%, 36%, and 51% decreased risk of BCR, DM, or PCSM, respectively, compared with White men, after adjusting for age and disease characteristics. The study found no differences in these outcomes among men receiving radiotherapy plus long-term ADT.
Kishan AU, Romero T, Rettig M, et al. Association of black race with improved outcomes following definitive radiotherapy with androgen deprivation therapy for high-risk prostate cancer: A meta-analysis of eight randomized trials. Presented at: ASTRO 2020 virtual annual meeting. Abstract 2866.