Black men with nonmetastatic prostate cancer (nmPCa) do not appear to have worse survival than their white counterparts when access to care and standardized treatment are provided, according to new study findings published in JAMA Oncology.
Robert T. Dess, MD, of the University of Michigan in Ann Arbor, and colleagues compared survival outcomes for black and white men with T1-4 nmPCa using 3 cohorts with different viewpoints: the population-based Surveillance, Epidemiology, and End Results (SEER) registry, the “equal access” Veterans Affairs (VA) health care system, and a pool of 4 Radiation Therapy Oncology Group (RTOG) phase 3 randomized clinical trials that provided standardized treatment for all participants regardless of race.
“To our knowledge, this study represents the most comprehensive analysis to date of the association of black race with outcomes in nonmetastatic prostate cancer among men diagnosed with similar stage disease,” Dr Dess and colleagues wrote.
In the VA and RCT cohorts, all patients received surgery and radiotherapy, respectively, whereas in SEER, patients received radical treatment, hormone therapy, or conservative management. Collectively, the analysis included 306,100 men with nmPCa (mean age 65 years), of whom approximately 55,000 were black.
In the SEER registry, black race was associated with a 30% increased risk of PCa-specific mortality (PCSM) after age adjustment, a 17% increase after age and stage adjustment, and a 9% increase after full adjustment, including for socioeconomic and insurance status.
The team ultimately found only a 0.5% absolute increase in PCSM at 10 years for black vs white men. Investigators observed no significant difference among high-risk patients and no significant difference in PCSM in the VA cohort. In the RCT cohort, black men had a significantly lower hazard for PCSM.
In SEER and the RCT cohorts, blacks had a significant 30% and 17% higher risk of death from causes other than PCa.
“With similar access to care and standardized treatment, black men with nonmetastatic prostate cancer appeared to have comparable stage-for-stage prostate cancer–specific mortality to white men,” the authors wrote.
In an accompanying editorial, Channing J. Paller, MD, and colleagues at Johns Hopkins University in Baltimore, observed: “By controlling for access to care and quality of care through clinical settings where prostate cancer is treated, Dess and colleagues provide powerful evidence that equal treatment yields equal outcome among equal patients. It is an unsettling fact that there is not equal treatment in the United States. African Americans, other minorities, and the poor in general often experience disparate quality of care or no care at all. Although race does not matter biologically, race still matters.”
Dess RT, Hartman ME, Mahal BA, et al. Association of black race with prostate cancer-specific and other-cause mortality. JAMA Oncol. Published online May 23, 2019. doi:10.1001/jamaoncol.2019.0826
Paller CJ, Wang L, Brawley OW. Racial inequality in prostate cancer outcomes—socioeconomics, not biology. Published online May 23, 2019. JAMA Oncol. doi:10.1001/jamaoncol.2019.0812
Study examines association of being black with death from prostate cancer (news release). JAMA Oncol.