Improved Outcomes Associated with Black Race following Definitive Radiotherapy with Androgen Deprivation Therapy for High-risk Prostate Cancer

Presenting author:
Amar U. Kishan, MD

By Eulanca Y. Liu, PhD, University of California San Diego School of Medicine

In the current social and political climate, amid the ongoing, contentious battle for racial equality, physicians are striving to look within their own fields for a better understanding of the intersection of pathophysiological and environmental contributions to racial inequities in health care outcomes. In their study, 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, Amar Kishan, MD, at the University of California, Los Angeles, and colleagues, sought to investigate the conflicting reports of prognostic importance of Black race for patients with prostate cancer.

The natural history of prostate cancer is known to be prolonged, and the majority of men with localized disease generally die with, rather than from, prostate cancer. Yet historically, Black men are more likely to die of prostate cancer than white men, possibly because they present on average with more aggressive disease. However, emerging data “have suggested that Black men actually have better survival in the metastatic prostate cancer setting provided they receive comparable treatment as white men with similar burdens of disease,” explained Dr. Kishan through e-mail correspondence. The authors thus sought to evaluate whether differences in early response to therapy could be identified. They found that, in the context of randomized trials, Black men receiving definitive radiation treatment “actually have better early and late markers of treatment response than white men,” despite the fact that Black men have more aggressive disease at the time of starting treatment. These markers included lower 10-year rates of biochemical recurrence, distant metastasis and prostate cancer-specific mortality.

“This is important because it suggests that the well-known disparity in survival between white men and Black men with prostate cancer may be driven more by issues related to access and receipt of standard of care treatments than by an inherently more treatment-recalcitrant disease.” Dr. Kishan emphasized that this does not reflect Black men’s proclivity to develop prostate cancer, but rather that, once diagnosed, Black men at least have equivalent treatment outcomes following radiotherapy.

When asked about the overarching reach of this work, Dr. Kishan noted that these results add to the growing evidence challenging “the nihilism of a prostate cancer diagnosis among Black men, which would stipulate that outcomes are poor and more aggressive treatments are needed.” This idea of a poor prognosis has significant unnecessary effects on mental health, in addition to treatment intensification that is associated with adverse quality of life. This research also supports the importance of outreach, expanding access to care and the importance of enrolling minority groups in randomized clinical trials. “Without the efforts of RTOG/NRG oncology to enroll these men, we would never have been able to conduct this research,” said Dr. Kishan.

Armed with this information, Dr. Kishan and colleagues continue to seek to investigate a molecular or genomic explanation for the difference in treatment response, and, perhaps more imperatively, to answer the question “How do we improve access to care?” to better facilitate guideline concordant treatment for Black men with prostate cancer. These efforts will continue to drive the field forward in improved understanding of the contribution of biological versus nonbiological differences to better limit and eventually dissipate racial disparities in outcomes.

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 was presented on Sunday, October 25 in the Poster Hall, as part of Poster Viewing (PV) session 03.

Published on: October 26, 2020