African American (AA) men are more likely than non-AA men to have a comorbid illness that could interact with androgen-deprivation therapy (ADT) and shorten survival. This study assessed the impact that race had on the risk of all-cause mortality (ACM) and other-cause mortality (OCM) among men definitively treated for favorable-risk prostate cancer (PC).
Between 1997 and 2013, 7252 men with low-risk or favorable intermediate-risk PC were treated with brachytherapy with neoadjuvant ADT (n = 1501) or without neoadjuvant ADT (n = 5751) for a 4-month median duration. Cox and Fine-Gray multivariate regressions were used to analyze whether the risk of ACM and OCM increased among AA men versus non-AA men receiving ADT; adjustments were made for the age at brachytherapy, year of brachytherapy, cardiometabolic comorbidity status, risk group, and ADT treatment propensity score.
After a median follow-up of 8.04 years, 869 men (12.0%) died: 48 (5.52%) of PC and 821 (94.48%) of other causes. There was a significant association between AA race and an increased risk of both ACM (adjusted hazard ratio [AHR], 1.77; 95% confidence interval [CI], 1.06-2.94; P = .028) and OCM (AHR, 1.86; 95% CI, 1.08-3.19; P = .024) among AA men versus non-AA men who received ADT but not among those who did not receive ADT (AHR for ACM, 1.33; 95% CI, 0.93-1.91; P = .12; AHR for OCM, 1.39; 95% CI, 0.96-2.02; P = .08).
ADT use may shorten survival in AA men with favorable-risk PC; therefore, its reservation for the treatment of higher risk PC, for which level 1 evidence supports its use, should be considered. Cancer 2016. © 2016 American Cancer Society.
Cancer. 2016 Aug 04 [Epub ahead of print]
Konstantin A Kovtun, Ming-Hui Chen, Michelle H Braccioforte, Brian J Moran, Anthony V D'Amico
Harvard Radiation Oncology Program, Brigham and Women's Hospital-Dana-Farber Cancer Institute, Boston, Massachusetts., Department of Statistics, University of Connecticut, Storrs, Connecticut., Prostate Cancer Foundation of Chicago, Westmont, Illinois., Prostate Cancer Foundation of Chicago, Westmont, Illinois., Department of Radiation Oncology, Brigham and Women's Hospital-Dana-Farber Cancer Institute, Boston, Massachusetts.