Clinical Features and Body Composition in Men with Hormone-Sensitive Metastatic Prostate Cancer: A Pilot Study Examining Differences by Race

Abstract

Black men treated with frontline therapies for metastatic prostate cancer (MPC) show better clinical outcomes than non-Black men receiving similar treatments. Variations in body composition may contribute to these findings. However, preliminary data are required to support this concept. We conducted a retrospective cohort study for all men with MPC evaluated at our center over a 4-year period, collecting demographic and clinical data (N = 74). Of these, 55 men had diagnostic computed tomography images to quantify adipose tissue and skeletal muscle, specifically sarcopenia and myosteatosis. Nineteen men had repeat imaging to explore changes over time. Frequencies, medians, interquartile ranges, and time to event analyses (hazard ratios (HR); confidence interval (CI)) are presented, stratified by race. Overall, 49% (n = 27) of men had sarcopenia, 49% (n = 27) had myosteatosis, and 29% (n = 16) had sarcopenia and myosteatosis simultaneously. No significant relationship between body mass index (Log-rank p = 0.86 ; HR: 1.05, 95% CI: 0.45–2.49) or sarcopenia (Log-rank p = 0.92 ; HR: 1.01, 95% CI: 0.46–2.19) and overall survival was observed. However, the presence of myosteatosis at diagnosis was associated with decreased overall survival (Log-rank p = 0.09 ; HR: 2.34, 95% CI: 1.05–5.23), with more pronounced (statistically nonsignificant) negative associations for Black (HR: 4.39, 95% CI: 0.92–21.1, p = 0.06 ) versus non-Black men (HR: 1.89, 95% CI: 0.79–4.54, p = 0.16 ). Over the median 12.5 months between imaging, the median decline in skeletal muscle was 4% for all men. Black men displayed a greater propensity to gain more adipose tissue than non-Black men, specifically subcutaneous ( p = 0.01 ). Because of the potential for Type II errors in this pilot, future studies should seek to further evaluate the implications of body composition on outcomes. This will require larger, adequately powered investigations with diverse patient representation.

Influence of Androgen Deprivation Therapy on the Development of Sarcopenia in Patients with Prostate Cancer: A Systematic Review

“…The description of included studies is presented in Table 1 . Observational studies were conducted in ethnically diverse groups of PCa patients, where the sarcopenia was assessed either twice (at the baseline and in the follow up) [ 22 , 23 , 25 , 26 , 27 ] or only once during the ADT treatment [ 28 , 29 ]. The largest group of PCa patients was found in Chiang et al [ 25 ] and therefore this study will have the greatest impact on the meta-analysis performed.…”

“…However, the sarcopenia assessment methodology and time to follow up used in single studies were differentiated, which could influence the obtained results. Nevertheless, no association with progression-free survival or overall survival was indicted [ 22 , 23 , 25 ]) ( Table 5 ).…”

“…The fixed-effect or random-effect model was chosen. Korczak et al [ 22 ] and Sheean et al [ 23 ] presented data for two different populations independently (patients with hormone-sensitive prostate cancer (HSPC) or castration-resistant prostate cancer (CRPC) and Black or non-Black patients, respectively). Therefore, each population was considered separately in the meta-analysis.…”

The impact of race on survival in metastatic prostate cancer: a systematic literature review

“…Twenty-seven [ 20 , 22 , 25 , 27 , 30 , 31 , 33 – 36 , 38 , 41 , 48 , 49 , 51 – 58 , 60 , 62 , 70 , 71 , 78 ] of the 54 studies reported results on overall survival (OS) or all-cause mortality, 11 studies [ 21 – 24 , 26 , 31 , 37 , 38 , 44 , 50 , 61 ] reported results on prostate cancer specific mortality (PCSM), and 11 studies [ 29 , 32 , 39 , 46 , 62 – 65 , 73 , 77 , 80 ] reported results on OS or PCSM in patients on specific mPC treatments, with some of the studies reporting on more than one survival outcome. Nine studies [ 3 , 28 , 40 , 42 , 43 , 45 , 47 , 59 , 79 ] reported only descriptive data, described racial groups other than Black, White, Hispanic, Asian, or Native American, such as Maori, Thai, Malaysian, or conducted separate analyses within each racial group. An overview of these studies is included in Table A.…”

“…reporting on more than one survival outcome. Nine studies [3,28,40,42,43,45,47,59,79] reported only descriptive data, described racial groups other than Black, White, Hispanic, Asian, or Native American, such as Maori, Thai, Malaysian, or conducted separate analyses within each racial group. An overview of these studies is included in Table A.5.…”