Impact of Asian Race on Prognosis in De Novo Metastatic Prostate Cancer

Abstract

Background: Little is known about the impact of Asian race on the long-term survival outcomes of males with de novo metastatic prostate cancer (PCa). Understanding racial disparities in survival is critical for accurate prognostic risk stratification and for informing the design of multiregional clinical trials. Methods: This multiple-cohort study included individual patient-level data for males with de novo metastatic PCa from the following 3 cohorts: LATITUDE clinical trial data (n=1,199), the SEER program (n=15,476), and the National Cancer Database (NCDB; n=10,366). Primary outcomes were overall survival (OS) in LATITUDE and NCDB and OS and cancer-specific survival in SEER. Results: Across all 3 cohorts, Asian patients diagnosed with de novo metastatic PCa had better survival than white patients. In LATITUDE, median OS was significantly longer in Asian versus white patients in the androgen deprivation therapy (ADT) + abiraterone + prednisone group (not reached vs 43.8 months; hazard ratio [HR], 0.45; 95% CI, 0.28–0.73; P=.001) as well as in the ADT + placebo group (57.6 vs 32.7 months; HR, 0.51; 95% CI, 0.33–0.78; P=.002). In SEER, among all patients diagnosed with de novo metastatic PCa, median OS was significantly longer in Asian versus white males (49 vs 39 months; HR, 0.76; 95% CI, 0.68–0.84; P<.001). Among those who received chemotherapy, Asian patients again had longer OS (52 vs 42 months; HR, 0.71; 95% CI, 0.52–0.96; P=.025). Using data on cancer-specific survival in SEER resulted in similar conclusions. In NCDB, Asian patients also had longer OS than white patients in aggregate and in subgroups of males treated with ADT or chemotherapy (aggregate: 38 vs 26 months; HR, 0.72; 95% CI, 0.62–0.83; P<.001; ADT subgroup: 41 vs 26 months; HR, 0.71; 95% CI, 0.60–0.84; P<.001; chemotherapy subgroup: 34 vs 25 months; HR, 0.67; 95% CI, 0.57–0.78; P<.001). Conclusions: Asian males have better OS and cancer-specific survival than white males with metastatic PCa across different treatment regimens. This should be considered when assessing prognosis and in designing multinational clinical trials.

Authors’ Reply to the Letter to the Editor by Nguyen et al

“…A recent NCDB analysis found significant differences among Asian American subgroups when compared with White patients, with most of these subgroups showing greater odds of presenting in a higher PCa risk group. 2 This disaggregation enables us to acknowledge the intricacies within different Asian communities. It may also allow better comparison of various Asian clinical trial cohorts and explain why certain trials do not find racial/ethnic differences in survival between Asian and White patients in the mPCa setting.…”

“…3 Second, it is vital to further explore why Asian patients with PCa, despite often presenting at a higher stage, achieve better outcomes compared with their White counterparts. 2,4 Investigating this phenomenon could yield valuable information that benefits patients from all backgrounds. Although the finding that similarity between clinical trial and real-world data may suggest biologic distinctions unique to Asian individuals, we must also explore the possibility that the provision of care closer to that of clinical trials may explain the superior outcomes observed in their real-world Asian cohorts.…”