Association of black race with improved outcomes following definitive radiotherapy with androgen deprivation therapy for high-risk prostate cancer: A meta-analysis of eight randomized trials.

Authors

Amar Kishan

Amar Upadhyaya Kishan

Department of Radiation Oncology, University of California, Los Angeles, CA

Amar Upadhyaya Kishan , Tahmineh Romero , Matthew Rettig , Isla Garraway , Mack Roach III, Thomas Michael Pisansky , Jeff M. Michalski , W. Robert Lee , Christopher U. Jones , Seth A. Rosenthal , Felix Y Feng , Paul Christopher Boutros , Nicholas George Nickols , Brandon Arvin Virgil Mahal , Robert Timothy Dess , Phuoc T. Tran , Michael L. Steinberg , David Elashoff , Howard M. Sandler , Daniel Eidelberg Spratt

Organizations

Department of Radiation Oncology, University of California, Los Angeles, CA, Department of Medicine Statistics Core, University of California, Los Angeles, CA, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, David Geffen School of Medicine, UCLA, Los Angeles, CA, University of California San Francisco, San Francisco, CA, Mayo Clinic, Rochester, MN, Washington University in St. Louis School of Medicine, St. Louis, MO, Duke University Medical Center, Durham, NC, Sutter General Hospital Accruals-Radiological Associates of Sacramento, Sacramento, CA, Sutter General Hospital, Sacramento, CA, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, Ontario Institute for Cancer Research, Toronto, ON, Canada, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, Harvard Radiation Oncology Program, Boston, MA, University of Michigan, Ann Arbor, MI, Johns Hopkins School of Medicine, Baltimore, MD, University of California Los Angeles, Los Angeles, CA, Cedars-Sinai Medical Center, Los Angeles, CA, Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

No funding received
None.

Background: Though Black men with prostate cancer are more likely to have aggressive disease features than White men, race-specific differences in initial treatment responses in localized disease remains unknown. Methods: Individual patient data were obtained for 9259 patients (including 1674 [18.1%] Black men and 7585 [81.9%] White men) enrolled on eight randomized controlled trials evaluating definitive radiotherapy (RT) ± short-term or long-term androgen deprivation therapy (STADT and LTADT). The primary endpoints were biochemical recurrence (BCR), distant metastasis (DM), and prostate cancer-specific mortality (PCSM). Fine-Gray subdistribution HR (sHR) models were developed to evaluate the cumulative incidences of all endpoints after stratification by National Comprehensive Cancer Network risk grouping. A meta-analysis was done to estimate pair-wise comparisons of treatments within and between Black and White men, after adjusting for age, Gleason score, clinical T stage, and initial PSA. Results: Black men were more likely to have NCCN high-risk disease at enrollment (656/1674 [39.2%] vs 2506/7585 [33%], p<0.001). However, within the high-risk stratum Black men had lower 10-year rates of BCR (46.1% vs. 50.4%, p=0.02), DM (14% vs. 21.6%, p<0.001), and PCSM (4.9% vs. 9.8%, p<0.001). After adjusting for age and disease characteristics, Black men with high-risk prostate receiving RT+STADT had lower rates of BCR (sHR 0.73, 95% CI 0.62-0.86, p<0.001), DM (sHR 0.64, 95% CI 0.49-0.84, p=0.001) and PCSM (sHR 0.49, 95% CI 0.25-0.95, p=0.04). There were no differences in BCR, DM, or PCSM among men receiving RT+LTADT. The interaction between race and the impact of adding STADT to RT alone on BCR was statistically significant (p=0.003). Conclusions: Black men enrolled on randomized trials with long-term follow-up have higher risk disease at enrollment, but have better BCR, DM, and PCSM outcomes with RT-based therapy compared with White men, particularly with the addition of STADT.

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Abstract Details

Meeting

2020 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Prostate Cancer

Track

Prostate Cancer - Advanced,Prostate Cancer - Localized

Sub Track

Therapeutics

Citation

J Clin Oncol 38, 2020 (suppl 6; abstr 327)

Abstract #

327

Poster Bd #

M11

Abstract Disclosures