Hormone therapy may shorten survival in African American men with low- or intermediate-risk prostate cancer

This study examined the effect of ethnicity on health outcomes with androgen deprivation therapy (ADT). Researchers reported shorter survival among African American men receiving ADT for low- or intermediate-risk prostate cancer compared to men of other ethnicities.

ADT is a type of hormone therapy used to treat prostate cancer. By reducing the levels of male sex hormones active in prostate cancer (such as testosterone), cancer progression can be delayed and survival increased. ADT is often used to treat advanced prostate cancer, including cancer that has spread to other parts of the body. ADT can also be combined with other treatments, such as radiation therapy, for a more intensive treatment of localized prostate cancer. Brachytherapy is a form of radiation therapy where a radiation source is placed directly inside the prostate.

ADT is usually not recommended for men that have many other medical conditions due to the various side effects associated with it. Men of African American ethnicity are more likely to have both other medical conditions and quicker prostate cancer progression requiring a more intensive intervention early on. Whether ADT is a safe and effective additional treatment for African American men with lower risk prostate cancer is still under investigation.

The aim of this study was to examine the effect of ethnicity on health outcomes with ADT.

The records of 7,252 men with low- or intermediate-risk prostate cancer were included in analysis. Of these, 1,501 men were treated with brachytherapy plus 4 months of ADT. 5,751 men were treated with brachytherapy alone. 7.3% of men were African American (AA). Patients were followed for an average of 8 years.

On average, AA men were younger, more likely to have intermediate-risk prostate cancer, and more likely to have additional medical conditions affecting heart health compared to non-AA men.

12% of men died during the study period. Of these, 5.5% died from prostate cancer. AA men treated with brachytherapy plus ADT were 77% more likely to die from any cause and 86% more likely to die from a cause other than prostate cancer compared to non-AA men undergoing the same treatment. Mortality risk was also increased for AA men undergoing brachytherapy alone, but this was not statistically significant. There were no prostate cancer-related deaths among AA men, regardless of treatment.

Researchers concluded that short ADT use was associated with poorer survival among African American men with low- or intermediate-risk prostate cancer. Researchers suggest that ADT use in African American men should be reserved for high-risk prostate cancer.

Further studies that randomly assign patients to ADT and non-ADT treatment groups are needed to further establish the effect of ADT on mortality risk in African American men.

Always discuss the risks and benefits of any treatment with your doctor.