Prostate cancer: black patients do not have higher mortality risk

  • Dess RT & al.
  • JAMA Oncol
  • 23 May 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In newly diagnosed patients with prostate cancer, the difference in mortality risk by race was observed in population-based study, but not in the equal-access health care system.
  • In randomized clinical trials (RCTs), black patients had a lower mortality risk.

Why this matters

  • Findings suggest socioeconomic factors influence mortality differences in black patients rather than biological differences.

Study design

  • Study of individual patient-level data of 306,100 patients with newly diagnosed nonmetastatic prostate cancer from Surveillance, Epidemiology, and End Results (SEER), Veterans Affairs health system (VA), and 4 National Cancer Institute-sponsored phase 3 RCTs.
  • Inverse probability weighting was performed to adjust for imbalances by races.
  • Funding: Prostate Cancer Foundation.

Key results

  • Median follow-up, 75-104 months.
  • 17.8%-38.1% of the patients were black.
  • Black men in the SEER database had lower socioeconomic status, non-Medicaid insurance rate, curative treatment.
  • Black patients had a significantly higher risk for:
    • SEER cohort: cancer-specific, other cause, and all-cause mortality (subdistribution HR [sHR], 1.09, 1.30, 1.26, respectively; all P<.001>
    • RCT cohort: other-cause mortality (sHR, 1.17; P=.002).
  • Black patients had a lower risk for cancer-specific mortality in RCTs (sHR, 0.81; P=.04).
  • In the VA cohort, black men did not show worse cancer-specific, other-cause, or all-cause mortality (P=.46, .26, and .42, respectively).

Limitations

  • Retrospective design.

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