ADT and Black Men

The bad news about black men and prostate has gotten even worse. They have always been more likely to develop the disease and are nearly 2.4 times as likely to die from the disease. Now researchers are warning that definitive treatment with androgen deprivation therapy increases the risk for death among black men with low- or favorable-risk prostate cancer. They have published their study results in the journal Cancer.

ADT is frequently combined with radiation therapy for the treatment of men with intermediate- or high-risk prostate cancer. No evidence suggests that this treatment platform benefits patients with low- or favorable-risk disease.

“African American men are more likely than non–African American men to have comorbid illness that could interact with ADT and shorten survival,” Anthony V. D’Amico, MD, PhD, professor of medicine at Harvard Medical School and chief of genitourinary radiation oncology at Brigham and Women’s Hospital and Dana-Farber Cancer Institute, and colleagues wrote. “However, they are also more likely to harbor occult high-grade/stage prostate cancer despite low-risk prostate cancer indices, and ADT use is often required to maximize survival. Because of this dilemma, it remains unanswered whether the use of neoadjuvant ADT in favorable-risk prostate cancer to reduce prostate size and facilitate brachytherapy (but with no known curative benefit) is helpful or harmful in African American men.”

D’Amico and colleagues evaluated data from 7,252 men (median age, 68.1 years; interquartile range [IQR], 62.2-73.1) treated for low- or favorable-risk prostate cancer at the Chicago Prostate Cancer Center between October 1997 and May 2013.

All men received brachytherapy with or withoutneoadjuvant ADT for 4 months.

Black men comprised 7.3% of the study cohort.

Risks for all-cause mortality, disease-specific mortality and other-cause mortality served as the study’s primary endpoint. The researchers defined follow-up as the period between the end of brachytherapy to either date of death or date of final data update.

Median follow-up for the entire cohort was 8.04 years.

Black men tended to be younger, receive treatment later in the study period, have favorable-risk disease rather than low-risk disease, and have a baseline cardiometabolic comorbidity.

Owing to treatment delays, median follow-up was significantly shorter for black men, for both those who received ADT and those who did not.

The researchers observed 869 deaths during follow-up: 48 deaths were attributable to prostate cancer, and the remaining 821 were due to other causes.

Multivariate analyses showed that black men who received ADT had an increased risk for all-cause mortality and other-cause mortality.

In contrast, black men did not have a significantly increased risk for all-cause mortality or other-cause mortalityif they did not receive ADT.

No disease-specific deaths occurred among black men included in the study cohort.

The researchers acknowledged study limitations, including the retrospective design and the significantly shorter follow-up period among black men who received ADT, which may have influenced the number of mortality events.

“The use of ADT in African American men should be reserved for treating higher-risk prostate cancer, for which level-one evidence supports its use,” D’Amico and colleagues wrote. “Further study of the biological basis of the increased mortality risk in African American men receiving ADT is warranted.”