Headline: Forget everything you know about race-based prostate cancer biology.
The Study: We’re all taught that black men have more aggressive prostate cancers than white men. How do we know this? Put simply, the fact that they have over twice the prostate cancer mortality rate. The key to understanding the upcoming data is that this stat is based on national databases, not trial data where patients receive highly standardized treatments. This meta-gene analysis included tissue samples from thousands of men enrolled in all types of prostate cancer trials. What’s interesting: black men have way less androgen receptor activity and way more losses in DNA repair mechanisms. What’s fascinating: black men had significantly more genomically-predicted radio-sensitive tumors, in line with their noted DNA repair issues. What’s mind-blowing: this prompted a clinical meta-analysis of over 5800 patients enrolled in prospective RTOG trialsof whom over 1100 were blackand it demonstrated superior biochemical control (HR 0.81), rates of distant mets (HR 0.71), and even prostate cancer-specific survival (HR 0.81) among black versus white men.
Bottom Line: Black men with prostate cancer have unique tumor genomics which, at least on trial, translate to better cancer outcomes with standard radiation regimens than seen with white men. Whoa. | Spratt, ASTRO 2018


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