Rationale: Understand the survival outcomes of black and white Veterans with metastatic castration-resistant prostate cancer (mCRPC).
Background: Black men have a higher incidence of prostate cancer and are more likely to be diagnosed at an earlier age, have a more aggressive disease at presentation and experience worse clinical outcome than white men. Evidence has shown that at diagnosis race is associated with disease progression, however, few studies have examined whether race is associated with survival in men once they reach an advanced stage of the disease. This study examines the survival outcomes among black and white men with mCRPC treated in the Veterans Health Administration (VHA).
Methods: Patient information from the Veterans Affairs (VA) Central Cancer Registry and the VA Corporate Data Warehouse was used to identify patients who were diagnosed with prostate cancer and later developed mCRPC, defined as: (1) Radiologic evidence of metastasis obtained from radiology reports using a natural language processing algorithm; (2) Evidence of rising prostate-specific antigen (PSA); and (3) Evidence of ongoing androgen deprivation consisting of a serum testosterone level of 50 ng/dL. Patient demographics, disease characteristics and treatment practices, and survival outcomes were extracted.
Results: From 2006 to 2015, 120,374 patients were diagnosed and treated with prostate cancer in the VHA; with 3,637 developing mCRPC. At diagnosis 2,429 (67%) were white, 1,066 (29%) were black, and 142 (4%) were reported as other. Compared to white men, black men were younger (66 vs 69 years) and had a higher PSA (92 vs 41 ng/mL), although there were no differences in disease characteristics
(Gleason score and stage) and early treatments (radiation prostatectomy, surgical orchiectomy, castration by agonists, castration by agonists/androgen deprivation). There were no significant differences between black and white men with mCRPC and their overall survival on both univariable (HR, .95; P = .203) or multivariable (HR, 1.0; P = .971) analyses.
Conclusions: Consistent with prior reports, black men are more likely to develop mCRPC than white men, although once black men progress to advanced disease, a multivariable analysis suggests that race is not associated with overall survival.