Incidence, outcomes, ethnicity, and distant, de novo, metastatic prostate cancer


Diagnosis of men with distant, metastatic prostate cancer at first presentation (distant, “de novo”, metastatic prostate cancer) is a lot less common today than it was 30 or 40 years ago, but it does still happen on a regular basis.

In a newly published article in the journal Cancer, Bernard et al. looked at data on the incidence and outcomes of distant, de novo, metastatic prostate cancer here in America between 2004 and 2012, using the most recent update to the Surveillance, Epidemiology, and End Results (SEER) registry data. All such patients would potentially be hormone-sensitive at time of diagnosis and could be expected to benefit (at least a little, and sometimes a lot) from androgen deprivation therapy (ADT) and, most recently, chemohormonal therapy with ADT + docetaxel.

Here is a summary of their basic findings regarding incidence and outcomes:

  • Compared to all newly diagnosed prostate cancer patients in the SEER database during the 8-year time frame, distant, de novo, metastatic prostate cancer was diagnosed in
    • 4.2 percent of non-Hispanic whites
    • 5.8 percent of Hispanic whites
    • 5.7 percent of blacks
    • 5.5 percent of Asians/Pacific Islanders
    • 8.8 percent of native Americans/Alaskans
  • Average (median) overall survival was
    • 30 months among men of Asian ethnicity
    • 24 to 25 months among men of all other ethnicities
  • Average (median) prostate cancer-specific mortality was
    • 54 months among men of Asian ethnicity
    • 35-40 months among men of all other ethnicities

In other words, men of Asian ethnicity appear to respond about 20 to 40 percent better to initial ADT in this scenario than men of other ethnicities.

Bernard et al. also looked at the outcomes of the men in the CHAARTED trial (E3805), who were also all initially diagnosed with distant, de novo, metastatic prostate cancer and who were treated with the combination of ADT + docetaxel chemotherapy. In this study:

  • Average (median) overall survival of the men treated with ADT + docetaxel was
    • 58.1 months among non-Hispanic whites
    • 57.6 months in blacks
    • Too few men of Asian ethnicity were enrolled to make a determination

The authors conclude that

  • Asian men who are diagnosed with distant, de novo, metastatic prostate cancer tend to respond better to treatment with ADT and other follow-up forms of treatment than men of other ethnicities.
  • Black and non-Hispanic white males diagnosed with distant, de novo, metastatic prostate cancer seem to have similar responses to initial combination chemohormonal therapy.

As far as your sitemaster is aware, we have no good explanation at present as to why Asian Americans would respond better than Americans of other ethnicities to ADT for distant, de novo, metastatic prostate cancer, but it does seem to be the case.

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