Race and outcomes after prostate brachytherapy


A new retrospective analysis of data from > 2,300 patients suggests that African-American men are a greater risk for biochemical disease recurrence after brachytherapy alone than Hispanics or Caucasian men, but there is no relationship between race and risk for metastatic disease, prostate cancer-specific mortality, or overall mortality.

Yamoah et al, looked at the data from 2,301 men, all of whom had received low-dose-rate brachytherapy (“seed implantation”) at their institution between June 1990 and October 2008 and who had been followed for at least 2 years post-treatment. Patients received treatment with either brachytherapy alone or brachytherapy in combination with external beam radiation therapy (EBRT) and/or androgen deprivation therapy (ADT)>

  • The series included 2,268 patients eligible for analysis.
    • 81 percent were Caucasian.
    • 12 percent were African American.
    • 6 percent were Hispanic.
    • 1 percent were Asian.
  • The overall 10-year actuarial rates of freedom from biochemical recurrence were
    • 70 percent for African Americans
    • 83 percent for Caucasians
    • 86 percent for Hispanics
  • African Americans presented with higher PSA levels and higher risk disease than Caucasians.
    • 44 percent of African Americans had a PSA level > 10 ng/ml at diagnosis.
    • 21 percent of Caucasians had a PSA level > 10 ng/ml at diagnosis.
  • Among patients diagnosed with low-risk prostate cancer, 10-year actuarial rates of freedom from biochemical recurrence were
    • 76 percent for African Americans
    • 90 percent for Caucasians
  • Among patients who received brachytherapy alone, the 10-year rates of biochemical disease-free survival were
    • 61 percent for African Americans
    • 86 percent for Caucasians
  • Among men who received brachytherapy combined with ADT with or without supplemental EBRT, there was no difference in the rates of biochemical disease-free survival.
  • Based on a multivariate analysis, six factors were significant predictors of 10-year freedom from biochemical recurrence:
    • PSA level at diagnosis (P = 0.024)
    • Gleason score at diagnosis (P < 0.001)
    • The biologic effective dose of brachytherapy radiation (P < 0.001)
    • Supplemental EBRT (P = 0.002)
    • Supplemental ADT (P = 0.03)
    • African-American race (P =0.037)
  • There were no significant differences in overall survival, cause-specific survival, or distant metastasis-free survival between racial groups.

The authors conclude that African-American race “appeared to be an independent negative predictor” of freedom from biochemical failure after prostate brachytherapy. They further suggest that “this result may highlight the need for more aggressive therapy in this patient population.”

The “New” Prostate Cancer InfoLink, however, would also emphasize the final result reported by Yamoah et al., which implies that:

  • There was no correlation between risk for biochemical recurrence after prostate brachytherapy and risk for metastatic disease.
  • There was no correlation between risk for biochemical recurrence after prostate brachytherapy and risk for prostate cancer-specific mortality.
  • There was no correlation between risk for biochemical recurrence after prostate brachytherapy and race-specific risk for metastasis or mortality.

In other words, even though African Americans appear to be at higher risk for biochemical recurrence than Caucasians and Hispanics after prostate brachytherapy, their risk for serious, clinically significant disease appears to remain the same.

One Response

  1. In other words, men with higher-risk disease had more biological recurrence regardless of race.

    I’m wondering why the authors did not stratify their results by risk category. I’m suspecting it’s because they would have had too few African-American men in at least one of the three risk groups to permit statistically meaningful analysis, but it would have been nice to see at least low level statistics by risk group.

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