The effect of race on survival after local therapy in metastatic prostate cancer patients

Local therapy (LT) may offer a survival advantage in highly select newly diagnosed metastatic prostate cancer (mPCa) patients. However, it is unknown whether the benefits vary according to Caucasian vs. African American (AA) patients.

Within the Surveillance Epidemiology and End Results database (2004-2014), we focused on Caucasians and AA patients with newly diagnosed mPCa treated with LT: radical prostatectomy (RP) and brachytherapy (RT). Endpoints consisted of cancer-specific mortality (CSM) and overall mortality (OM). Kaplan-Meier analyses and multivariable Cox regression models tested for racial difference in CSM and OM.

Between 2004 and 2014, we identified 408 (77.2%) Caucasians and 121 (22.8%) AAs with newly diagnosed mPCa treated with LT: either RP (n=357) or RT (n=172). According to race, when LT is defined as RP, Caucasian patients had a significantly longer survival vs. AA patients: CSM-free survival 123 vs. 63 months (p=0.004) and OM-free survival 108 vs. 46 months (p=0.002). The CSM and OM benefits were confirmed in multivariable analyses (hazard ratio [HR] 0.56, p=0.01 for CSM; HR 0.60, p=0.01 for OM). However, no differences in CSM or OM were recorded according to race when LT consisted of RT.

Our results indicate that race is not associated with difference in survival after LT in mPCa patients. However, when focusing on RP-treated patients, Caucasian race is associated with higher CSM and OM rates relative to AA race. This racial difference does not apply to RT. Our findings should be considered in future prospective trials for the purpose of pre-planned stratification according to race.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2018 Oct 15 [Epub ahead of print]

Elio Mazzone, Marco Bandini, Felix Preisser, Sebastiano Nazzani, Zhe Tian, Firas Abdollah, Denis Soulieres, Markus Graefen, Francesco Montorsi, Shahrokh Shariat, Fred Saad, Alberto Briganti, Pierre Karakiewicz

Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Goethe-Universität Frankfurt am Main, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada., Henry Ford Health System, Detroit, MI, United States., Division of Medical Oncology/Hematology Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Martini-Clinic, Prostate Cancer Centre Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Medical University of Vienna, Vienna, Austria.