Boston—While androgen-deprivation therapy might allow life-saving treatment for some patients with prostate cancer, African-American men receiving the hormone therapy had a higher risk of death when compared to non-African American men, according to a retrospective study.
The medical records analysis of patients using ADT to reduce the size of the prostate to make them eligible for prostate brachytherapy was published recently in the journal Cancer.
For the study, Brigham and Women’s Hospital-led researchers analyzed the medical records of more than 7,000 men from the Chicago Prostate Cancer Center who had low or favorable-intermediate risk prostate cancer, 20% of whom were treated with ADT. Results indicate that African-American men who were treated with ADT had a 77% higher risk of death for reasons unrelated to prostate cancer, when compared to men of other races and ethnicities.
“When African-American men were exposed to an average of only four months of hormone therapy, primarily used to make the prostate small enough for brachytherapy, they suffered from higher mortality rates due to causes other than prostate cancer than non-African American men,” explained lead author Konstantin Kovtun, MD, a medical resident. “This leads us to believe that there may be something intrinsic to the biology of African-American men that predisposes them to this increased risk of death and that this deserves further study.”
After a median follow-up of 8.04 years, 869 men (12.0%) died, 5.52% of prostate cancer and 94.48% of other causes. The study identified a significant association between African-American race and an increased risk of both all-cause mortality, with an adjusted hazard ratio (AHR) of 1.77, and other-cause mortality, with an AHR of 1.86, among African-American men compared to others—but only if they received ADT.
Noting that the hormone treatment can shorten survival in African-American men with favorable-risk prostate cancer, the study suggests “its reservation for the treatment of higher risk PC, for which level 1 evidence supports its use, should be considered.
“These results show that careful consideration should be taken by physicians when recommending treatment for low or favorable-intermediate prostate cancer, a cancer that very few men die of even without treatment,” added Anthony D’Amico, MD, PhD, chief of Genitourinary Radiation Oncology at Brigham and Womens. “There is no evidence that ADT followed by brachytherapy increases the chance of cure in comparison to other treatments, such an external beam radiation therapy alone, in these men with favorable risk prostate cancer. The subsequent risks of ADT, specifically linked to African-American men, deserve further study.”
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