Black prostate cancer patients’ radiation treatment results better even with higher risk of disease

Patient going to radiology - cancer treatment
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Black men with more aggressive disease appeared to have better outcomes than their white counterparts in a meta-analysis of radiation therapy trials, according to a study by researchers at UCLA Jonsson Comprehensive Cancer Center.

“These findings provide high-level evidence that challenges the general belief that black men diagnosed with prostate cancer will necessarily have a worse prognosis than white men,” said Amar Kishan, associate professor and vice president of clinical and translational research at Department of Radiation Oncology at UCLA. Kishan is the co-senior author of an article in the December 29 issue of JAMA Network Open.

This is especially important because an unfounded belief can inadvertently contribute to ‘cancer injustice’, leading to the use of more aggressive treatments than may be necessary – potentially reducing the quality of life – and diverting attention away from other important factors that may impact the outcome, including access to more comprehensive health care, ”Kishan said.

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

Of the total, 1,630 men identified themselves as black and 7,184 as 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.

Ting Martin Ma, chief physician in the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA, said black men are more likely to be diagnosed with prostate cancer than white men, and they have a double increased risk of dying. from the disease, but until now there have been no significant studies to assess race-specific differences in response to initial treatment.

“Although previous studies have shown that death from prostate cancer was similar for black men and white men – provided there is equal access to care and standardized treatments – death from prostate cancer is often the culmination of many years of rescue therapies and prostate cancer mortality. does not in itself capture the initial response to primary therapy, ”said Ma.

Co-senior author Daniel Spratt, chairman of the Department of Radiation Oncology at Seidman Cancer Center University Hospital, said: “Race is a social construct and therefore all observed findings must be seen through this lens; this includes the social and / or biological manifestations of structural racism. . “

Ma added that it is important to note that the men in these studies not only had access to clinical trials, but they signed up for trials where all patients received the same treatment. Because black men tend to be less willing to entertain the idea of ​​participating in clinical trials – a byproduct of medical mistrust – this fairness in accessing care and receiving treatment may not be representative of the general population.

“These results do not suggest that there are any biological differences that can cause differences in the incidence of prostate cancer between racial groups,” the authors said. “In fact, it is possible that the association with differentiated treatment response observed may be explained, at least in part, by differences in the underlying biology.”

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