The impact of race on biochemical disease-free survival in early-stage prostate cancer patients treated with surgery or radiation therapy

Purpose: To assess the impact of race on biochemical freedom from recurrenc e in patients with early-stage prostate cancer treated either by radical pr ostatectomy or radiation therapy. Methods: Between July 1989 and December 1994, 693 patients with early-stage prostate cancer were treated with radiation (302 patients) or by radical p rostatectomy (391 patients) at Barbara Ann Karmanos Cancer Institute/Wayne State University. Stage, Gleason score, race, pretreatment PSA, and follow- up PSA values were abstracted. There were 387 Caucasian males (CM) and 306 African-American males (AAM). None of the patients received hormone therapy . Radiation therapy was delivered using photon irradiation (249 patients, m edian dose 69 Gy) or mixed neutron/photon irradiation (53 patients, median dose 10 NGy + 38 PGy). Median follow-up was 36 months (range 2-70) for CM a nd 35 months (range 1-70) for AAM. Results: Thirty-seven percent of patients treated surgically were AAM, comp ared to 53% in the radiation group (p = 0.0001). AAM had a higher median pr ostate-specific antigen (PSA) than CM (9.78 ng/ml vs. 8.0 ng/ml, p = 0.01). Thirty-three percent of AAM had a pretreatment PSA greater than 15 ng/ml c ompared to 20% of CM (p = 0.00001). Disease-free survival (DFS) by race was equivalent at 36 months, 81% for CM and 77% for AAM (p = NS). For patients with PSA less than or equal to 15, DFS rates were 87% and 85% for CM and A AM, respectively. DFS rates for patients with PSA > 15 were 61% for CM and 64% for AAM (p = NS). Significant prognostic factors on multivariate analys is included pretreatment PSA (p = 0.0001) and Gleason score (p = 0.0001). Conclusion: Race does not appear to adversely affect biochemical disease-fr ee survival in males treated for early-stage prostate cancer. African-Ameri can males with early-stage prostate cancer should expect similar biochemica l disease-free survival rates to those seen in Caucasian males. (C) 1999 El sevier Science Inc.