PROSTATE-CANCER IN AFRICAN-AMERICAN MEN - OUTCOME FOLLOWING RADIATION-THERAPY WITH OR WITHOUT ADJUVANT ANDROGEN ABLATION

Purpose: To compare the outcome of irradiated clinically localized pro state cancer in African-American and white patients. Methods and Mater ials: This was a retrospective review of 1,201 men, 116 African-Americ an and 1,085 white, with T1-T3, N0/NX, M0 prostate cancer receiving ex ternal radiation between 1987 and 1996, Pretreatment characteristics, treatment parameters, and outcome (relapse or rising prostate-specific antigen [PSA] levels, local recurrence, metastatic relapse, and survi val) were compared between the groups using univariate and multivariat e statistical methods. Results: There were no significant differences between African-American and white patients in T-stage, Gleason score, prostatic acid phosphatase (PAP) level, and testosterone level. Afric an-Americans had a significantly lower incidence of abnormal digital r ectal findings and a proportionally higher incidence of obstructive ur inary symptoms at presentation and tended to be somewhat younger. A ma jor difference between the two groups was in the significantly higher PSA levels among African-Americans (median, 14 ng/ml) than among white patients (median, 9.5 ng/ml), This translated into a higher incidence of unfavorable disease according to our criteria (39% vs, 25%) among African-Americans and, thus, to the more frequent use of adjuvant andr ogen ablation and to somewhat higher radiation doses in these patients . With a median follow-up of 42 months the overall 6-year freedom from relapse for African-Americans was 63% compared to 61% for whites (p = 0.634), We found no significant differences in biochemical relapse ra tes between any subgroups of African-Americans and whites. Specificall y, even patients who did not have androgen ablation, when stratified b y PSA levels, had similar outcomes regardless of race, Likewise, local recurrence and metastasis rates were not significantly different betw een the two groups.Conclusions: Although African-American patients ten d to have higher pretreatment PSA levels than white patients, the outc ome for the disease is similar in the two groups when stratified by kn own pretreatment prognostic factors. Our data provide no evidence for the hypothesis that prostate cancer in African-Americans is intrinsica lly more virulent than in whites. (C) 1998 Elsevier Science Inc.