Racial Differences in Treatment Patterns and Health-Related Quality of Life Outcomes in Men with Localized Prostate Cancer

Differences in treatment patterns and health-related quality of life (HRQoL) between African American and non-African American men with localized prostate cancer were revealed in the results of a study presented by Natasza (Tasha) Posielski, MD from Virginia Mason Franciscan Health, Seattle, WA.1 It is well known that African American men have a higher incidence of prostate cancer, present with more advanced disease, and are more likely to receive non-surgical therapy, Dr Posielski noted. Although different treatments for localized prostate cancer are known to result in differing effects on HRQoL, racial differences in treatment patterns and HRQoL have been poorly studied.

To gain insight into these differences, Dr Posielski and her colleagues at Virginia Mason Franciscan Health examined racial differences in treatment patterns and HRQoL in a racially diverse cohort of men with prostate cancer who underwent active surveillance, or definitive management such as radical prostatectomy or radiation therapy. The researchers retrospectively reviewed data from 1006 men with low- or intermediate-risk prostate cancer enrolled in the Center for Prostate Disease Research (CPDR) multicenter database between 2007 and 2017. The CPDR database includes comprehensive demographic, clinical, treatment, and outcomes data from four military institutions as well as from Virginia Mason Center in Seattle. Information on general health, prostate cancer survivorship, and HRQoL has been prospectively collected with annual questionnaires since 2007. HRQoL is measured using the Expanded Prostate Cancer Index Composite (EPIC) and RAND 36 Item Short Form Health Survey (SF-36). For this study, HRQoL data collected at baseline and annually for 5 years were evaluated, and treatment patterns and HRQoL data compared and assessed individually for African American and non-African American men.

The cohort comprised 1006 men, including 223 (22.1%) African American men, and had a mean follow-up of 5.3 years, Dr Posielski reported. The researchers found that among men with low-risk prostate cancer, African American men were less likely than non-African American men to undergo active surveillance (28.5% vs 38.8%), and significantly more likely to receive radiation therapy (22.3% vs 10.6%, P<0.001). In patients with intermediate-risk prostate cancer, rates of active surveillance were similar in the two groups, but, again, African American men were more likely to receive radiation therapy (43.0% vs 26.9%, P=0.016). In this group they were also less likely to undergo radical prostatectomy (50.5% vs 66.8%).

Few significant differences were seen when HRQoL was compared in African American and non-African American men, Dr Posielski noted, with no statistically significant differences in urinary, bowel, sexual, or hormonal scores between patients undergoing either of the treatment options or active surveillance, except in sexual bother after radical prostatectomy. Findings were similar among the SF-36 physical and mental components of the questionnaire.

Analysis by treatment showed that in African American and non-African American men, radical prostatectomy was associated with worse urinary and sexual function and bother compared with active surveillance or radiation therapy. Hormonal HRQoL was similar in both groups. Bowel HRQoL, however, although similar by treatment modality in African American men, in non-AA men, radiation therapy was associated with worse bowel scores compared with active surveillance or radical prostatectomy.

Dr Posielski stressed the strengths of the study, which included the diverse population studied, long follow-up, and the lack of access-related or socioeconomic bias due to many of the patients being treated within the military healhcare system. In addition, analyses were adjusted for disease factors that may have impacted HRQoL. Limitations of the study included its being retrospective, potential for miscoding, and loss to follow-up.

From this research, Dr Posielski and her colleagues concluded that African American men have lower rates of active surveillance in low risk and higher rates of radiation therapy in low-and intermediate-risk prostate cancer. They may have worse urinary and sexual bother after prostatectomy, but the effect of radiation therapy on bowel HRQoL appears to be worse in non-African American men. “Individual counseling is key,” the researcher’s stress.

References

Posielski N, Ho O, Jiang J, et al. The effect of race on treatment patterns and health-related quality of life outcomes in men undergoing treatment for localized prostate cancer. Poster #218 presented at the 22nd Annual Meeting of the Society of Urologic Oncology (SUO), December 1-3, 2021, Orlando, FL.