Editor's Commentary - Impact of race on biochemical disease recurrence after prostate brachytherapy

BERKELEY, CA (UroToday.com) - It is known that African American (AA) men with prostate cancer (CaP) often present with higher stage and grade disease, present at an earlier age and have higher mortality rates.

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.

PubMed Abstract
PMID: 21692058

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