In the online version of Cancer, Dr. Kosj Yamoah and associates report the impact of race on biochemical disease-free-survival (BDFS) in men treated with prostate brachytherapy.
The study cohort consisted of 2,268 men with CaP treated with low-dose brachytherapy and followed for a minimum of 24 months. All were treated at the Mount Sinai Medical Center between 1990 and 2008 and intermediate and high-risk patients received combination therapy with external beam radiotherapy or androgen deprivation therapy (ADT). Patients were classified by race- and risk-groups. Low-risk disease was treated with Iodine-124 monotherapy while intermediate and high-risk disease was treated with palladium-103 seed combined with XRT if the seminal vesicles were positive on biopsy and ADT.
Demographic distribution was 1,831 men (81%) Caucasian, 270 (12%) AA, 141 (6%) Hispanic, and 26 men (1%) Asian. AA men presented at an earlier age and more often had PSA levels >10ng/ml, but Gleason scores did not differ between groups. The 10-year freedom from biochemical failure (FFbF) rate was 79% for AA men, and 84% for all other groups. The 10-year BDFS was significantly better for Caucasian men compared with AA men, but did not differ between Caucasian men and Hispanic men. The 10-year overall survival (OS) rate for AA, Caucasian, and Hispanic men was 80.5%, 79.5%, and 69.5%, respectively. The 10-year cause-specific survival (CSS) rate for AA, Caucasian, and Hispanic men was 96%, 98%, and 100%, respectively. There was not a statistical difference in OS, CSS, or distant-metastasis free survival between racial groups. More AA men (24%) were diagnosed with high-risk CaP and thus underwent combination therapy as compared with Caucasian men (15%). Comparing 10-year FFbF between Caucasian and AA men for low-risk disease showed rates of 90% and 76%, respectively, for intermediate-risk disease 81% and 72%, respectively, and for high-risk disease there was no difference. Only Gleason score and clinical stage contributed significantly to this difference. For men who received seed implants without XRT or ADT, Caucasian men had a 10-year BDFS of 86% compared with 61% for AA men. Other findings suggested that AA men with low- or intermediate-risk disease might require higher radiation doses to improve biochemical disease control. After controlling for other variables, AA race still remained a negative predictor of FFbF.
Cancer. 2011 Jun 20. Epub ahead of print.