Study: Although they tend to be diagnosed with

Researchers at the UCLA Jonsson Comprehensive Cancer Center conducting a meta-analysis of seven randomized trials found an “unexpected result”: Although black men appeared to have more aggressive disease when they enrolled in clinical trials of radiation therapy for the prostate cancer, their treatment outcomes, and disease-specific outcomes were better than their white counterparts.

“These results provide high-level evidence challenging the common belief that black men who are diagnosed with prostate cancer will necessarily have a worse prognosis than white men,” said Dr. Amar Kishan, Associate Professor and Vice Chairman of Clinical and Translational Research in the Department of Radiation Oncology at UCLA and Investigator at the UCLA Jonsson Comprehensive Cancer Center. Kishan is co-lead author of an article in the December 29 issue of Open JAMA Network [DOI: 10.1001/jamanetworkopen.2021.39769].

“This is particularly important because an unfounded belief can inadvertently contribute to ‘cancer injustice’, leading to the use of more aggressive treatments than necessary – potentially reducing quality of life – and diverting attention from other factors. that can influence outcomes, including access to more comprehensive health care,” said Kishan, chief of genitourinary oncology in the department of radiation oncology at the David Geffen School of Medicine. UCLA and the UCLA Jonsson Comprehensive Cancer Center.

Dr. Ting Martin Ma, resident physician in the Department of Radiation Oncology at UCLA’s David Geffen School of Medicine and a researcher at the UCLA Jonsson Comprehensive Cancer Center, said black men are more likely to be diagnosed with cancer prostate than white men. , and they have a twice as high risk of dying from the disease, but so far there have been no significant studies to assess breed-specific differences in response to initial treatment.

“Although previous studies have shown that prostate cancer deaths were similar for black and white men – provided there was equal access to standardized care and treatment – the cancer death of prostate is often the culmination of many years of multiple salvage therapies, and prostate cancer mortality does not inherently reflect initial responsiveness to primary treatment.Here, we investigated early measures of treatment response, including biochemical recurrence (increase in PSA above a threshold) or development of distant metastases in men with localized prostate cancer, which is also the predominant disease state in patients. will help identify potential drivers and mitigators of disparities in prostate cancer care,” said Ma, co-first author with Tahmineh Romero, st senior atistician in the Department of Medicine at UCLA.

Co-lead author Dr. Daniel Spratt, chair of the Department of Radiation Oncology at the Seidman Cancer Center University Hospitals, said: “Race is a social construct, and therefore any observed findings must be viewed through this lens; this includes social and/or biological manifestations of structural racism.

Ma added that it’s important to note that the men in these studies not only had access to clinical trials, but had enrolled in trials in which all patients received the same treatment. Because black men tend to be less willing to consider participating in clinical trials—a byproduct of medical mistrust—this equity in access to care and receipt of treatment may not be representative of the population. general.

Additionally, most deaths that occur among black and white men are from causes other than prostate cancer. “This underscores the importance of health care in general, which can influence survival outcomes at the population level,” Kishan said.

In what is believed to be the largest meta-analysis of its kind on the subject, researchers looked at individual data from 8,814 patients from seven randomized clinical trials of radiation therapy for prostate cancer – studies which recruited significant numbers of black men and were conducted by the Radiation Oncology (RTOG)/NRG Oncology Group. All patients in the trials received standard or high-dose radiation therapy, and some patients also underwent short- or long-term androgen deprivation therapy.

Of the total, 1,630 men identified as black; 7184 in white. Overall, black men were younger, with a median age of 68 versus 71, and they were significantly more likely to have high-risk disease. To investigate associations between race and treatment effectiveness, the researchers extracted and analyzed statistics on recurrence (biochemical recurrence, or BCR), metastasis (distant metastasis, or DM), and cancer-specific mortality from prostate, or PCSM, and other secondary endpoints.

According to the results, black men were significantly younger and more likely to have high-risk disease at the time of treatment, but they had lower rates of recurrence, metastasis and PCSM than white men, even without adjustment. statistical. When adjustments were made for age and other factors, “race remained significantly associated with improved BCR, DM, and PCSM scores,” the authors reported in the paper. “The fact that black men had improved early and late disease outcomes compared to white men is a novel and unexpected finding that underscores that black men may have a better response to their initial treatment.”

“These results do not suggest that there are no biological differences that might lead to differences in prostate cancer incidence between racial groups,” the authors said. “In fact, it is possible that the association with the differential treatment response that is noted may be, at least in part, explained by differences in the underlying biology.”

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