Addition of ADT to radiation specially benefits black patients of prostate cancer:JAMA

Prostate cancer is a significant health concern, with racial disparities affecting outcomes and treatment responses. Previous studies suggested that Black men might have heightened sensitivity to radiation therapy, resulting in better outcomes in equal-access settings. However, the impact of ADT on these outcomes has remained uncharacterized until now. This study aimed to explore the modification of prostate cancer outcomes by ADT in Black men receiving radiation therapy.

The study analyzed data from 26,542 patients (8,716 Black and 17,826 White) treated between 2000 and 2020. All patients received definitive radiation therapy for localized prostate cancer, with some receiving ADT within six months of radiation. The main outcomes measured were biochemical recurrence (BCR), development of metastatic disease, and prostate cancer mortality (PCSM).

• Among the patients studied, 5,144 experienced BCR, including 1,760 Black and 3,384 White patients.

• The cumulative incidence of BCR at 10 years was similar between Black and White men (22.14% vs 20.13%, respectively).

• However, key differences emerged when ADT was considered.

• Black men receiving ADT had a lower hazard ratio (HR) for BCR (0.90, 95% CI, 0.82-0.99; P = .03) compared to White men.

• Conversely, without ADT, Black men had a higher HR for BCR (1.13, 95% CI, 1.05-1.22; P = .002).

• Black men showed a decreased risk of developing metastatic disease (HR, 0.90; 95% CI, 0.82-0.98; P = .02) and a significantly lower risk of prostate cancer mortality (subdistribution HR, 0.72; 95% CI, 0.63-0.82; P < .001) from the time of BCR.

The study highlights that Black men with prostate cancer benefit significantly from the addition of ADT to radiation therapy, achieving better biochemical control and reduced rates of metastasis and mortality. These findings suggest that ADT may play a crucial role in enhancing the radiosensitivity of prostate cancer in Black patients, leading to improved clinical outcomes.

This study underscores the importance of ADT in conjunction with radiation therapy for Black men with localized prostate cancer. The addition of ADT not only enhances biochemical control but also reduces the risk of metastatic disease and mortality. Future research should further investigate the role of ADT in modifying radiosensitivity and improving prostate cancer outcomes in Black patients.

Reference:

Morgan, K. M., Riviere, P., Nelson, T. J., Guram, K., Deshler, L. N., Sabater Minarim, D., Duran, E. A., Banegas, M. P., & Rose, B. S. (2024). Androgen deprivation therapy and outcomes after radiation therapy in Black patients with prostate cancer. JAMA Network Open, 7(6), e2415911. https://doi.org/10.1001/jamanetworkopen.2024.15911