No Connection Found Between Race and Risk of Skeletal-Related Events or Increased Mortality in Advanced Prostate Cancer

Researchers indicate that the current data suggest that race does not have a negative prognostic effect in patients with castration-resistant prostate cancer with bone metastases.

Black men with newly diagnosed, bone metastatic castration-resistant prostate cancer (mCRPC) do not face an increased risk of skeletal-related events (SREs) and overall mortality, according to recent study findings published in Cancer.

The researchers indicated that these data suggest their efforts should be focused on better understanding the basis for the excess risk of aggressive prostate cancer in Black men by examining cancer development and progression in those with early-stage disease.

“To the best of our knowledge, the prognostic impact of race on the outcomes of men with more advanced forms of prostate cancer remains understudied,” the study authors wrote. “We observed no association between Black race and the risk of SREs and overall mortality, indicating that once men develop bone mCRPC, race may not be an adverse prognostic factor.”

A common complication of bone metastases, SREs could lead to negative consequences in patients with mCRPC. Those complications could include severe pain, increased risk of death and increased health care costs.

In the retrospective study, investigators examined 837 patients from eight Veterans Affairs (VA) hospitals around the U.S. who were newly diagnosed with bone mCRPC in the year 2000 or later. Of the total, 232 Black patients (28%) and 605 non-Black patients (72%) were identified.

Researchers found that Black men were more likely to have bone metastases at the time of diagnosis (29%) compared to non-Black men (19%). Black men were also found to have higher prostate-specific antigen (PSA) levels (41.7 ng/mL vs. 29.2 ng/mL) and a longer time from diagnosis to metastasis (17.9 months vs. 14.3 months).

The median follow-up after diagnosis of metastasis was 25.9 months among those who were still alive at the time of data analysis. Researchers found no differences between the two groups when evaluating the risk of developing an SRE, which occurred in 287 patients (35%).

Mortality rates between Black and non-Black patients from the time of diagnosis of bone mCRPC were also evaluated. While 740 men (88%) died during follow-up, on crude analysis, race was not found to be related to overall mortality risk.

According to the researchers, “These current data suggest that race does not have a negative prognostic effect in patients with mCRPC. These results are consistent with prior studies from our group using the same cohort, wherein we identified predictors of SREs and race did not enter the model.”

Notably, though the inclusion of only patients from VA hospitals was a benefit because it included patients who had equal access to care, researchers noted that this fact could make the results difficult to extrapolate to other patient populations. Additionally, because these patients were treated outside of a clinical trial setting, the anticancer therapies used to treat patients across both groups were not standardized.

“Moreover, along with our mortality data, these data add to the increasing evidence that the greatest benefits to understanding racial disparities in prostate cancer would occur if efforts are focused on cancer development and progression in patients with early-stage disease,” the authors concluded.

A version of this article appeared on Cancer Network as “No Association Found Between Black Race and Risk of Skeletal-Related Events in mCRPC