Racial Disparity in Prostate Cancer-Specific Mortality for High-Risk Prostate Cancer: A Population-Based Study

Wang, Chenyang; Kamrava, Mitchell; King, Chris; Steinberg, Michael L.

doi:10.7759/cureus.961

Cited by 9 publications

(17 citation statements)

References 28 publications

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“…Our study preserve the trend observed in various studies which have shown significant race disparities in PCa with AAM enduring the worst survival outcome [13,17,[30][31][32][33]. Using a similar approach to account for competing risk, a recent study by Wang et al [17] reported high risk of PCSM among AAM. In another study by Tyson et al, authors reported significantly worse survival among AAM compared to white men [30].…”

Section: Discussionsupporting

confidence: 86%

African‐American men and prostate cancer‐specific mortality: a competing risk analysis of a large institutional cohort, 1989–2015

Williams¹,

Awasthi

Fink

et al. 2018

Cancer Medicine

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Significant racial disparities in prostate cancer (PCa) outcomes have been reported, with African‐American men (AAM) more likely to endure adverse oncologic outcomes. Despite efforts to dissipate racial disparities in PCa, a survival gap persists and it remains unclear to what extent this disparity can be explained by known clinicodemographic factors. In this study, we leveraged our large institutional database, spanning over 25 years, to investigate whether AAM continued to experience poor PCa outcomes and factors that may contribute to racial disparities in PCa. A total of 7307 patients diagnosed with PCa from 1989 through 2015 were included. Associations of race and clinicodemographic characteristics were analyzed using chi‐square for categorical and Mann–Whitney U‐test for continuous variables. Racial differences in prostate cancer outcomes were analyzed using competing risk analysis methods of Fine and Gray. Median follow‐up time was 106 months. There were 2304 deaths recorded, of which 432 resulted from PCa. AAM were more likely to be diagnosed at an earlier age (median 60 vs. 65 years, P = <0.001) and were more likely to have ≥1 comorbidities (13.6% vs. 7.5%, P < 0.001). In a multivariate competing risk model, adjusted for baseline covariates, AAM experienced significantly higher risk of PCSM compared to NHW men (HR, 1.62, 95% CI, 1.02–2.57, P = 0.03) NHW. Among men diagnosed at an older age (>60 years), racial differences in PCSM were more pronounced, with AAM experiencing higher rates of PCSM (HR, 2.05, 95% CI, 1.26–3.34, P = 0.003). After adjustment of clinicodemographic and potential risk factors, AAM continue to experience an increased risk of mortality from PCa, especially older AAM. Furthermore, AAM are more likely to be diagnosed at an early age and more likely to have higher comorbidity indices.

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Section: Discussionsupporting

confidence: 86%

African‐American men and prostate cancer‐specific mortality: a competing risk analysis of a large institutional cohort, 1989–2015

Williams¹,

Awasthi

Fink

et al. 2018

Cancer Medicine

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“…This discrepancy between the results of our study and that of others may be due to biological and racial differences. Previous studies have also indicated that there may be racial differences in the treatment response of certain cancers to radiotherapy . In addition, our results showed that higher radiation doses (>4,000 cGy) were more likely to achieve a complete response compared with lower radiation doses (≤4,000 cGy).…”

Section: Discussionsupporting

confidence: 74%

Clinical features of Kaposi's sarcoma: experience from a Taiwanese medical center

et al. 2019

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Background Most of the previous reports regarding the clinical features of Kaposi's sarcoma (KS) have been performed in Western and African countries. The clinical characteristics of KS have not been well defined in Han Chinese or Taiwanese patients. In this study, we analyzed the clinical features of KS patients in a Taiwanese medical center. Methods Medical records from Kaohsiung Medical University Hospital over the past 20 years (1996–2016) were comprehensively reviewed. Results There were 55 patients with KS (50 males and 5 females), including 37 patients (67%) with classic disease, 17 patients (31%) with AIDS‐associated disease, and one patient (2%) with immunosuppressive medication‐related disease. The average age was 58.7 years (range 20–87 years), and the average age was younger for AIDS patients (33.8 years) compared with non‐AIDS patients (69.8 years). Among patients with classic KS, lesions were mostly localized to the lower extremities, whereas AIDS‐associated KS patients were more likely to develop disseminated skin lesions, skin lesions on atypical sites (head and neck, trunk), and extracutaneous involvement (particularly oral cavity). The most common underlying diseases were diabetes mellitus (20% of patients) and hepatitis B (15% patients), and 38% of KS patients were smokers. Patients with AIDS‐associated KS usually responded well to chemotherapy, whereas only 32% of patients with non‐AIDS‐associated KS showed complete response to radiotherapy. Conclusions The findings of the current study will serve as important references for clinicians in the diagnosis of KS and may form the basis for the implementation of KS clinical practice guidelines in Taiwan.

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“…Prostate cancer survival among American men has improved over recent decades; however, it remains the most common cancer in all races, the second leading cause of cancer death in Whites, Blacks, and Hispanic men, and the fourth leading cause of cancer death in Asian Americans and Pacific Islanders (AAPIs) in the United States 1 . Racial disparities in prostate cancer survival are well documented 2‐9 . Black men not only have a higher incidence rate of prostate cancer but also are more than twice as likely to die of the disease in comparison with White men 10‐12 .…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in mortality for patients with prostate cancer after radical prostatectomy

Wen

Luckenbaugh

Bayley

et al. 2020

Cancer

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Background Although racial disparities in prostate cancer survival are well documented, the relative importance of contributing factors remains unclear. Few studies have examined the disparity between Whites and Hispanics or between Whites and Asian Americans and Pacific Islanders (AAPIs). Methods Using data from the National Cancer Database for 526,690 patients with prostate cancer who underwent radical prostatectomy between 2004 and 2014, this study systematically evaluated the impact of clinical characteristics and factors related to access to care on survival by race. Included in the analysis were 432,640 White patients (82.1%), 63,602 Black patients (12.1%), 8990 AAPI patients (1.7%), and 21,458 Hispanic patients (4.1%). Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals to measure racial survival disparities. Inverse probability weighting was used to adjust for imbalances of prognostic factors. Results When adjustments were made for age and year of diagnosis only, Blacks had 51% higher mortality, AAPIs had 22% lower mortality, and Hispanics had 6% lower mortality than Whites. Overall, with adjustments for all clinical factors and nonclinical factors, the Black‐White survival disparity narrowed to 20%, whereas the AAPI‐White disparity increased to 35%. Among the controlled‐for factors, education, median household income, and insurance status contributed the most to the racial disparity. Conclusions The overall survival disparity among men undergoing radical prostatectomy was significantly decreased, but not eliminated, for Blacks and significantly increased for AAPIs in comparison with Whites after adjustments for a number of clinical factors and factors related to access to care.

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Racial Disparity in Prostate Cancer-Specific Mortality for High-Risk Prostate Cancer: A Population-Based Study

Cited by 9 publications

References 28 publications

African‐American men and prostate cancer‐specific mortality: a competing risk analysis of a large institutional cohort, 1989–2015

African‐American men and prostate cancer‐specific mortality: a competing risk analysis of a large institutional cohort, 1989–2015

Clinical features of Kaposi's sarcoma: experience from a Taiwanese medical center

Racial disparities in mortality for patients with prostate cancer after radical prostatectomy

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