Randomized trials demonstrated improved survival in metastatic prostate cancer (mPCa) with the adoption of several systemic therapies. However, real-world data validating this effect and quantifying its magnitude in years of life lost (YLL) according to race/ethnicity are unavailable.
In surveillance, epidemiology, and end results (SEER) database (2004-2021), Caucasian, African American, Hispanic, and Asian/Pacific Islander mPCa patients aged 40-80 years treated in androgen deprivation therapy (ADT, 2004-2012), docetaxel (2013-2016), abiraterone (2017-2018), and androgen receptor pathway inhibitor (ARPI, 2019-2021) eras were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). YLL were quantified for mPCa patients and controls.
Overall, 36,658 mPCa patients were identified: 22,725 (62.0%) Caucasians, 6956 (19.0%) African Americans, 4785 (13.0%) Hispanics, and 2192 (6.0%) Asians/Pacific Islanders. In the ADT era, YLL values were 10.7 in African Americans, 9.0 in Hispanics, 8.4 in Caucasians, and 6.5 in Asians/Pacific Islanders. In the docetaxel era, YLL values were 9.4 in African Americans, 8.4 in Hispanics, 7.3 in Caucasians, and 6.2 in Asians/Pacific Islanders. In the abiraterone era, YLL values were 8.4 in African Americans, 6.3 in Hispanics, 5.4 in Caucasians, and 4.4 in Asians/Pacific Islanders. In the ARPI era, YLL values were 4.3 in African Americans, 3.6 in Hispanics, 2.7 in Caucasians, and 1.7 in Asians/Pacific Islanders.
YLL values decreased with each novel treatment era, in all race/ethnicity groups. The most pronounced decrease in YLL values occurred with the introduction of ARPIs, in all race/ethnicity groups. Despite those survival advances, African Americans were invariably disadvantaged as evidenced by the highest YLL values.
The Prostate. 2026 Jun 23 [Epub ahead of print]
Leonardo Quarta, Michele Petix, Maximilian Filzmayer, Filippo Orlandi, Federico Polverino, Jordan A Goyal, Matteo Ferro, Felix K H Chun, Salvatore Micali, Nicola Longo, Shahrokh F Shariat, Francesco Barletta, Armando Stabile, Giorgio Gandaglia, Francesco Montorsi, Fred Saad, Alberto Briganti, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy., Department of Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany., Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Modena, Italy., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.