Abstract
Importance: Black men have a 2-fold increased risk of dying from prostate cancer compared with White men. However, race-specific differences in response to initial treatment remain unknown. Objective: To compare overall and treatment-specific outcomes of Black and White men with localized prostate cancer receiving definitive radiotherapy (RT). Data Sources: A systematic search was performed of relevant published randomized clinical trials conducted by the NRG Oncology/Radiation Therapy Oncology Group between January 1, 1990, and December 31, 2010. This meta-analysis was performed from July 1, 2019, to July 1, 2021. Study Selection: Randomized clinical trials of definitive RT for patients with localized prostate cancer comprising a substantial number of Black men (self-identified race) enrolled that reported on treatment-specific and overall outcomes. Data Extraction and Synthesis: Individual patient data were obtained from 7 NRG Oncology/Radiation Therapy Oncology Group randomized clinical trials evaluating definitive RT with or without short- or long-term androgen deprivation therapy. Unadjusted Fine-Gray competing risk models, with death as a competing risk, were developed to evaluate the cumulative incidences of end points. Cox proportional hazards models were used to evaluate differences in all-cause mortality and the composite outcome of distant metastasis (DM) or death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Main Outcomes and Measures: Subdistribution hazard ratios (sHRs) of biochemical recurrence (BCR), DM, and prostate cancer-specific mortality (PCSM). Results: A total of 8814 patients (1630 [18.5%] Black and 7184 [81.5%] White) were included; mean (SD) age was 69.1 (6.8) years. Median follow-up was 10.6 (IQR, 8.0-17.8) years for surviving patients. At enrollment, Black men were more likely to have high-risk disease features. However, even without adjustment, Black men were less likely to experience BCR (sHR, 0.88; 95% CI, 0.58-0.91), DM (sHR, 0.72; 95% CI, 0.58-0.91), or PCSM (sHR, 0.72; 95% CI, 0.54-0.97). No significant differences in all-cause mortality were identified (HR, 0.99; 95% CI, 0.92-1.07). Upon adjustment, Black race remained significantly associated with improved BCR (adjusted sHR, 0.79; 95% CI, 0.72-0.88; P <.001), DM (adjusted sHR, 0.69; 95% CI, 0.55-0.87; P =.002), and PCSM (adjusted sHR, 0.68; 95% CI, 0.50-0.93; P =.01). Conclusions and Relevance: The findings of this meta-analysis suggest that Black men enrolled in randomized clinical trials present with more aggressive disease but have better BCR, DM, and PCSM with definitive RT compared with White men, suggesting that other determinants of outcome, such as access to care, are important factors of achieving racial equity.
Original language | English (US) |
---|---|
Article number | LBA5009 |
Journal | JAMA network open |
Volume | 4 |
Issue number | 12 |
DOIs | |
State | Published - Dec 29 2021 |
Funding
Funding/Support: This study was supported by grants P50CA09213 (Dr Kishan) and P50CA186786 (Dr Spratt) from the Prostate Cancer National Institutes of Health (NIH) Specialized Programs of Research Excellence (Dr Kishan), grant RSD1836 from the Radiological Society of North America (Dr Kishan), the STOP Cancer Organization (Dr Kishan), the Jonsson Comprehensive Cancer Center (Dr Kishan), grants PC151068 (Dr Spratt) and W81XWH-17-1-0302 (Dr Feng) from the Department of Defense, the Prostate Cancer Foundation (Drs Spratt and Mahal), and grant T32 CA-083654 from the NIH (Ms Hartman). Conflict of Interest Disclosures: Dr Nickols reported receiving grants from Bayer, personal fees from Oncolinea, grants from Lantheus, and grants from Janssen outside the submitted work. Dr Rettig reported receiving consultant fees from Clovis, Ambrx, Amgen, and Roivant; speakers’ fees from Janssen and Bayer; grants from Novartis, and nonfinancial support from Merck outside the submitted work; Dr Rettig had a patent for inhibitor of AR N-terminus pending. Dr Nguyen reported receiving grants from Astellas, Janssen, and Bayer, and consulting and speakers’ fees from Astellas, Janssen, Bayer, Boston Scientific, Blue Earth Diagnostics, Cota, Myovant outside the scope of the submitted work. Dr Feng reported receiving consultant fees from Janssen, Blue Earth Diagnostics, Myovant, Roivant, Astellas, Bayer, and BMS; serving on the scientific advisory board and holding stock options in SerImmune and BlueStar Genomics, consult fees from Exact Sciences and Varian, and holding stock in Artera Stock outside the submitted work. Dr Boutros reported receiving grants from the National Cancer Institute during the conduct of the study and sitting on the scientific advisory boards of BioSymetrics Inc, Intersect Diagnostics Inc, and Sage Bionetworks. Dr Chamie receiving consultant fees from UroGen Pharma. Dr Steinberg reported receiving honoraria from Viewray for consulting and speaking fees outside the scope of the submitted work. Dr Sandler reported receiving fees for sitting on a clinical trial steering committee for Janssen and holding stock in and having an inactive role on the medical advisory board of Radiogel outside the submitted work; and is a member of the ASTRO board of directors. Dr Spratt reported receiving consulting and speaking fees from Janssen, Blue Earth, AstraZeneca, and from Boston Scientific outside the scope of the submitted work. Dr Kishan reported receiving consultant fees from Varian Medical Systems Inc and ViewRay Inc, research support and consulting fees from Intelligent Automation Inc, and consulting fees and personal fees for serving on the advisory board of Janssen Pharmaceuticals Inc outside the submitted work. No other disclosures were reported.
ASJC Scopus subject areas
- General Medicine