Does race predict the development of metastases in men who receive androgen-deprivation therapy for a biochemical recurrence after radical prostatectomy?

Adriana C. Vidal, Lauren E. Howard, Amanda De Hoedt, Christopher J. Kane, Martha K. Terris, William J. Aronson, Matthew R. Cooperberg, Christopher Amling, Stanislav Lechpammer, Scott C. Flanders, Stephen J. Freedland

Research output: Contribution to journalArticle

Abstract

Background: In this study among men who underwent radical prostatectomy (RP), African American men (AAM) were 28% more likely to develop recurrent disease compared with Caucasian men (CM). However, among those who had nonmetastatic, castration-resistant prostate cancer (CRPC), race did not predict metastases or overall survival. Whether race predicts metastases among men who receive androgen-deprivation therapy (ADT) after a biochemical recurrence (BCR) (ie, before CRPC but after BCR) is untested. Methods: The authors identified 595 AAM and CM who received ADT for a BCR that developed after RP between 1988 and 2015 in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database. Univariable and multivariable Cox models were used to test the association between race and the time from ADT to metastases. Secondary outcomes included the time to CRPC, all-cause mortality, and prostate cancer-specific mortality. Results: During a median follow-up of 66 months after ADT, 62 of 354 CM (18%) and 38 of 241 AAM (16%) developed metastases. AAM were younger at the time they received ADT (63 vs 67 years; P <.001), had received ADT in a more recent year (2008 vs 2006; P <.001), had higher prostate-specific antigen levels at RP (11.1 vs 9.2 ng/mL; P <.001), lower pathologic Gleason scores (P =.004), and less extracapsular extension (38% vs 48%; P =.022). On multivariable analysis, there was no association between race and metastases (hazard radio, 1.20; P =.45) or any of the other secondary outcomes (all P >.5). Conclusions: Among veterans who received ADT post-BCR after RP, race was not a predictor of metastases or other adverse outcomes. The current findings suggest that research efforts to understand racial differences in prostate cancer biology should focus on early stages of the disease (ie, closer to the time of diagnosis).

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2018

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Prostatectomy
Androgens
Neoplasm Metastasis
Recurrence
Prostatic Neoplasms
African Americans
Castration
Therapeutics
Cancer Care Facilities
Mortality
Veterans
Proportional Hazards Models
Databases
Survival
Research

Keywords

  • androgen-deprivation therapy (ADT)
  • metastasis
  • outcomes
  • prostate cancer
  • race

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Vidal, A. C., Howard, L. E., De Hoedt, A., Kane, C. J., Terris, M. K., Aronson, W. J., ... Freedland, S. J. (Accepted/In press). Does race predict the development of metastases in men who receive androgen-deprivation therapy for a biochemical recurrence after radical prostatectomy? Cancer. https://doi.org/10.1002/cncr.31808

Does race predict the development of metastases in men who receive androgen-deprivation therapy for a biochemical recurrence after radical prostatectomy? / Vidal, Adriana C.; Howard, Lauren E.; De Hoedt, Amanda; Kane, Christopher J.; Terris, Martha K.; Aronson, William J.; Cooperberg, Matthew R.; Amling, Christopher; Lechpammer, Stanislav; Flanders, Scott C.; Freedland, Stephen J.

In: Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Vidal, AC, Howard, LE, De Hoedt, A, Kane, CJ, Terris, MK, Aronson, WJ, Cooperberg, MR, Amling, C, Lechpammer, S, Flanders, SC & Freedland, SJ 2018, 'Does race predict the development of metastases in men who receive androgen-deprivation therapy for a biochemical recurrence after radical prostatectomy?', Cancer. https://doi.org/10.1002/cncr.31808
Vidal, Adriana C. ; Howard, Lauren E. ; De Hoedt, Amanda ; Kane, Christopher J. ; Terris, Martha K. ; Aronson, William J. ; Cooperberg, Matthew R. ; Amling, Christopher ; Lechpammer, Stanislav ; Flanders, Scott C. ; Freedland, Stephen J. / Does race predict the development of metastases in men who receive androgen-deprivation therapy for a biochemical recurrence after radical prostatectomy?. In: Cancer. 2018.
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title = "Does race predict the development of metastases in men who receive androgen-deprivation therapy for a biochemical recurrence after radical prostatectomy?",
abstract = "Background: In this study among men who underwent radical prostatectomy (RP), African American men (AAM) were 28{\%} more likely to develop recurrent disease compared with Caucasian men (CM). However, among those who had nonmetastatic, castration-resistant prostate cancer (CRPC), race did not predict metastases or overall survival. Whether race predicts metastases among men who receive androgen-deprivation therapy (ADT) after a biochemical recurrence (BCR) (ie, before CRPC but after BCR) is untested. Methods: The authors identified 595 AAM and CM who received ADT for a BCR that developed after RP between 1988 and 2015 in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database. Univariable and multivariable Cox models were used to test the association between race and the time from ADT to metastases. Secondary outcomes included the time to CRPC, all-cause mortality, and prostate cancer-specific mortality. Results: During a median follow-up of 66 months after ADT, 62 of 354 CM (18{\%}) and 38 of 241 AAM (16{\%}) developed metastases. AAM were younger at the time they received ADT (63 vs 67 years; P <.001), had received ADT in a more recent year (2008 vs 2006; P <.001), had higher prostate-specific antigen levels at RP (11.1 vs 9.2 ng/mL; P <.001), lower pathologic Gleason scores (P =.004), and less extracapsular extension (38{\%} vs 48{\%}; P =.022). On multivariable analysis, there was no association between race and metastases (hazard radio, 1.20; P =.45) or any of the other secondary outcomes (all P >.5). Conclusions: Among veterans who received ADT post-BCR after RP, race was not a predictor of metastases or other adverse outcomes. The current findings suggest that research efforts to understand racial differences in prostate cancer biology should focus on early stages of the disease (ie, closer to the time of diagnosis).",
keywords = "androgen-deprivation therapy (ADT), metastasis, outcomes, prostate cancer, race",
author = "Vidal, {Adriana C.} and Howard, {Lauren E.} and {De Hoedt}, Amanda and Kane, {Christopher J.} and Terris, {Martha K.} and Aronson, {William J.} and Cooperberg, {Matthew R.} and Christopher Amling and Stanislav Lechpammer and Flanders, {Scott C.} and Freedland, {Stephen J.}",
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AU - Vidal, Adriana C.

AU - Howard, Lauren E.

AU - De Hoedt, Amanda

AU - Kane, Christopher J.

AU - Terris, Martha K.

AU - Aronson, William J.

AU - Cooperberg, Matthew R.

AU - Amling, Christopher

AU - Lechpammer, Stanislav

AU - Flanders, Scott C.

AU - Freedland, Stephen J.

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N2 - Background: In this study among men who underwent radical prostatectomy (RP), African American men (AAM) were 28% more likely to develop recurrent disease compared with Caucasian men (CM). However, among those who had nonmetastatic, castration-resistant prostate cancer (CRPC), race did not predict metastases or overall survival. Whether race predicts metastases among men who receive androgen-deprivation therapy (ADT) after a biochemical recurrence (BCR) (ie, before CRPC but after BCR) is untested. Methods: The authors identified 595 AAM and CM who received ADT for a BCR that developed after RP between 1988 and 2015 in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database. Univariable and multivariable Cox models were used to test the association between race and the time from ADT to metastases. Secondary outcomes included the time to CRPC, all-cause mortality, and prostate cancer-specific mortality. Results: During a median follow-up of 66 months after ADT, 62 of 354 CM (18%) and 38 of 241 AAM (16%) developed metastases. AAM were younger at the time they received ADT (63 vs 67 years; P <.001), had received ADT in a more recent year (2008 vs 2006; P <.001), had higher prostate-specific antigen levels at RP (11.1 vs 9.2 ng/mL; P <.001), lower pathologic Gleason scores (P =.004), and less extracapsular extension (38% vs 48%; P =.022). On multivariable analysis, there was no association between race and metastases (hazard radio, 1.20; P =.45) or any of the other secondary outcomes (all P >.5). Conclusions: Among veterans who received ADT post-BCR after RP, race was not a predictor of metastases or other adverse outcomes. The current findings suggest that research efforts to understand racial differences in prostate cancer biology should focus on early stages of the disease (ie, closer to the time of diagnosis).

AB - Background: In this study among men who underwent radical prostatectomy (RP), African American men (AAM) were 28% more likely to develop recurrent disease compared with Caucasian men (CM). However, among those who had nonmetastatic, castration-resistant prostate cancer (CRPC), race did not predict metastases or overall survival. Whether race predicts metastases among men who receive androgen-deprivation therapy (ADT) after a biochemical recurrence (BCR) (ie, before CRPC but after BCR) is untested. Methods: The authors identified 595 AAM and CM who received ADT for a BCR that developed after RP between 1988 and 2015 in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database. Univariable and multivariable Cox models were used to test the association between race and the time from ADT to metastases. Secondary outcomes included the time to CRPC, all-cause mortality, and prostate cancer-specific mortality. Results: During a median follow-up of 66 months after ADT, 62 of 354 CM (18%) and 38 of 241 AAM (16%) developed metastases. AAM were younger at the time they received ADT (63 vs 67 years; P <.001), had received ADT in a more recent year (2008 vs 2006; P <.001), had higher prostate-specific antigen levels at RP (11.1 vs 9.2 ng/mL; P <.001), lower pathologic Gleason scores (P =.004), and less extracapsular extension (38% vs 48%; P =.022). On multivariable analysis, there was no association between race and metastases (hazard radio, 1.20; P =.45) or any of the other secondary outcomes (all P >.5). Conclusions: Among veterans who received ADT post-BCR after RP, race was not a predictor of metastases or other adverse outcomes. The current findings suggest that research efforts to understand racial differences in prostate cancer biology should focus on early stages of the disease (ie, closer to the time of diagnosis).

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