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Cancer-Specific and Other-Cause Mortality Among Black Men With Prostate Cancer

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Key Points

  • In adjusted analysis, black men did not appear to be at greater risk of prostate cancer–specific mortality vs white men.
  • Black men had greater risk of other-cause mortality.

In a study reported in JAMA Oncology, Dess et al found that after adjustment for nonbiologic differences, black men with nonmetastatic prostate cancer did not appear to have higher rates of prostate cancer–specific mortality vs white men. Black patients had higher rates of other-cause mortality. 

Study Details

The study involved individual patient-level data on men with clinical T1-4N0-1M0 prostate cancer from three cohorts: Surveillance, Epidemiology, and End Results (SEER; n = 296,273); five equal-access regional medical centers in the Veterans Affairs health system (VA; n = 3,972); and four pooled National Cancer Institute–sponsored Radiation Therapy Oncology Group phase III randomized clinical trials (RCTs; n = 5,854). Black men constituted 17.8% of the SEER cohort, 38.1% of the VA cohort, and 19.3% of the RCT cohort. Data from the cohorts were from January 1992 through December 2013. To adjust for baseline demographic-, cancer-, and treatment-related differences, inverse probability weighting (IPW) analysis was performed.

Risk of Cancer-Specific and Other-Cause Mortality

Black race was associated with increased age-adjusted prostate cancer–specific mortality risk vs white men in the SEER cohort (subdistribution hazard ratio [sHR] = 1.30, P < .001). After IPW adjustment, black race was associated with a 0.5% increase in cancer-specific mortality at 10 years after diagnosis (sHR = 1.09, P < .001), with no significant differences observed for high-risk men (sHR = 1.04, P = .29). No significant differences in prostate cancer–specific mortality for black vs white men were found in the VA IPW cohort (sHR = 0.85, P = .46). Black men had reduced risk in the RCT IPW cohort (sHR = 0.81, P = .04).

Black men had increased risk of other-cause mortality vs white men in the SEER (sHR = 1.30, P < .001) and RCT (sHR = 1.17, P = .002) IPW cohorts, but not in the VA IPW cohort (sHR = 1.08, P = .26).

The investigators concluded, “In this study, after adjustment for nonbiological differences, notably access to care and standardized treatment, black race did not appear to be associated with inferior stage-for-stage [prostate cancer–specific mortality]. A large disparity remained in [other-cause mortality] for black men with nonmetastatic prostate cancer.”

Daniel E. Spratt, MD, of the Department of Radiation Oncology, University of Michigan, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by the Prostate Cancer Foundation, National Institutes of Health, Department of Defense, and philanthropic support from patients. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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