Differences in Disease Presentation, Treatment Outcomes, and Toxicities in African American Patients Treated With Radiation Therapy for Prostate Cancer

Shah, Chirag; Jones, Pamela M.; Wallace, Michelle; Kestin, Larry L.; Ghilezan, M.; Fakhouri, Monty; Jaiyesimi, Ishmael; Ye, Hong; Martínez, Álvaro; Vicini, Frank A.

doi:10.1097/coc.0b013e3182208262

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…In contrast to the high rates of biochemical recurrence observed in African-American men undergoing radical prostatectomy, no difference in biochemical failure has been noted in African-American men receiving external beam radiation therapy (EBRT) [104][105][106][107] . More importantly, no difference in overall survival has been noted [107][108][109] .…”

Section: Treatment Outcome Differences For Localized Cancermentioning

confidence: 99%

Prostate cancer in men of African origin

2015

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Men of African origin are disproportionately affected by prostate cancer: prostate cancer incidence is highest among men of African origin in the USA, prostate cancer mortality is highest among men of African origin in the Caribbean, and tumour stage and grade at diagnosis are highest among men in sub-Saharan Africa. Socioeconomic, educational, cultural, and genetic factors, as well as variations in care delivery and treatment selection, contribute to this cancer disparity. Emerging data on single-nucleotide-polymorphism patterns, epigenetic changes, and variations in fusion-gene products among men of African origin add to the understanding of genetic differences underlying this disease. On the diagnosis of prostate cancer, when all treatment options are available, men of African origin are more likely to choose radiation therapy or to receive no definitive treatment than white men. Among men of African origin undergoing surgery, increased rates of biochemical recurrence have been identified. Understanding differences in the cancer-survivorship experience and quality-of-life outcomes among men of African origin are critical to appropriately counsel patients and improve cultural sensitivity. Efforts to curtail prostate cancer screening will likely affect men of African origin disproportionately and widen the racial disparity of disease.

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Section: Treatment Outcome Differences For Localized Cancermentioning

confidence: 99%

Prostate cancer in men of African origin

2015

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“…However, on multivariate analysis after adjusting for risk categories and duration of adjuvant ADT, race no longer was associated with outcome. There are conflicting results regarding oncological outcomes in MAA with PCa treated with brachytherapy …”

Section: Causes For Prostate Cancer Disparitiesmentioning

confidence: 99%

“…134 This disparity is not clearly understood but may be due to racial or socioeconomic discrimination, MAA mistrust of the healthcare system or more PCa treated with brachytherapy. 143,144 Active surveillance spares men with low-risk and low-volume PCa (clinically insignificant), that will unlikely progress, of treatment-related morbidity. The surveillance protocol varies between centers; showing no significant upgrading or upstaging after RP.…”

Section: Clinicalmentioning

confidence: 99%

Disparities in prostate cancer incidence and mortality rates: Solvable or not?

et al. 2019

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Prostate cancer (PCa) is recognized as a disease possessing not only great variation in its geographic and racial distribution but also tremendous variation in its potential to cause morbidity and death and it, therefore, ought not to be considered a homogenous disease entity. Morbidity and death from PCa are disproportionately higher in men of African ancestry (MAA) who are generally observed to have more aggressive disease and worse outcomes following treatment compared to men of European ancestry (MEA). The higher rates of PCa among MAA relative to MEA appear to be multifactorial and related to inherent differences in biological aggressiveness; a continued lack of awareness of the disease and methods of prevention; a lower prevalence of screen‐detected PCa; comparatively lower access to quality healthcare as well as systemic and institutionalized disparities in the administration of optimal care to MAA in developed countries such as the United States of America where high‐quality care is available. Even when access to quality healthcare is assured in equal access settings, it appears that MAA still have worse outcomes after PCa treatment stage‐for‐stage and grade‐for‐grade compared to MEA, suggesting that, inherent racial, ethnic and biological differences are paramount in predicting poor outcomes. This review has explored the different contributing factors to the current disparities in PCa incidence and mortality rates with emphasis on the incongruence in how research has been conducted in understanding the disease towards developing therapies.

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“…Though somewhat conflicting, most reports suggest that that AA race is a significant predictor of aggressive disease in patients undergoing surgery [ 10 , 14 , 15 , 16 , 17 , 18 , 19 ], though not for RT [ 8 , 9 ]. Therefore, the predominance of AA patients in our population may account for differences in outcome reporting between our findings and the other aforementioned reports.…”

Section: Discussionmentioning

confidence: 99%

“…However, the generalizability of these data to all patient populations is unclear. While in the radiation literature, race does not appear to be a significant predictor for biochemical recurrence [ 8 , 9 ], the surgical literature has suggested that African American (AA) patients have more aggressive disease than indicated by current National Comprehensive Cancer Network (NCCN) risk stratification criteria with associated poorer outcomes than expected [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer

et al. 2015

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PurposeWe analyzed outcomes of patients with prostate cancer undergoing either radical retropubic prostatectomy (RRP) +/- salvage radiation or definitive radiation therapy (RT) +/- androgen deprivation.Materials and MethodsFrom 2003-2010 there were 251 patients who underwent RRP and 469 patients who received RT (≥7,560 cGy) for prostate cancer. Kaplan-Meier analysis was performed with the log-rank test to compare biochemical control (bCR), distant metastatic-free survival (DMPFS), and prostate cancer-specific survival (PCSS) between the two groups.ResultsThe median follow-up was 70 months and 61.3% of the men were African American. For low risk disease the 6-year bCR were 90.3% for RT and 85.6% for RRP (p = 0.23) and the 6-year post-salvage bCR were 90.3% vs. 90.9%, respectively (p = 0.84). For intermediate risk disease the 6-year bCR were 82.6% for RT and 59.7% for RRP (p < 0.001) and 82.6% vs. 74.0%, respectively, after including those salvaged with RT (p = 0.06). For high risk disease, the 6-year bCR were 67.4% for RT and 41.3% for RRP (p < 0.001) and after including those salvaged with RT was 67.4% vs. 43.1%, respectively (p < 0.001). However, there were no significant differences between the two groups in regards to DMPFS or PCSS.ConclusionTreatment approaches utilizing RRP +/- salvage radiation or RT +/- androgen deprivation yielded equivalent DMPFS and PCSS outcomes. Biochemical control rates, using their respective definitions, appeared equivalent or better in those who received treatment with RT.

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Differences in Disease Presentation, Treatment Outcomes, and Toxicities in African American Patients Treated With Radiation Therapy for Prostate Cancer

Abstract: Despite differences in presenting characteristics, AA men did not have inferior clinical outcomes but rather improved cause-specific survival when treated with standard of care radiation therapy. Regardless of the treatment modality used, toxicities between AA and W men were comparable.

Cited by 10 publications

References 11 publications

Prostate cancer in men of African origin

Prostate cancer in men of African origin

Disparities in prostate cancer incidence and mortality rates: Solvable or not?

Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer

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