African-American men negatively impacted by hormone therapy for treatment of prostate cancer
Boston, MA– In a retrospective study analyzing patients' medical records, researchers at Brigham and Women's Hospital found that patients' race significantly affected their longevity by increasing the likelihood of death after receiving androgen deprivation therapy (ADT). ADT was used to reduce the size of the prostate to make a patient eligible for prostate brachytherapy. These findings are published in the August 4, 2016 issue of Cancer.
Konstantin Kovtun, MD, a resident at BWH, Anthony D'Amico, MD, PhD, chief of Genitourinary Radiation Oncology at BWH, and colleagues, analyzed the medical records of over 7000 men from the Chicago Prostate Cancer Center who had low or favorable-intermediate risk prostate cancer, 20 percent of whom were treated with ADT in order to reduce the size of their prostate gland to make them eligible for brachytherapy. They found that African-American men who were treated with ADT had a 77 percent higher risk of death when compared to non-African American men, the causes of which were not due to prostate cancer.
"When African-American men were exposed to an average of only four months of hormone therapy, primarily used to make the prostate small enough for brachytherapy, they suffered from higher mortality rates due to causes other than prostate cancer than non-African American men," Kovtun explained. "This leads us to believe that there may be something intrinsic to the biology of African-American men that predisposes them to this increased risk of death and that this deserves further study."
ADT is an antihormone treatment that lowers a man's testosterone level, and been used to reduce the size of the prostate and in turn make the subsequent brachytherapy treatment possible. This team of BWH researchers is the first to observe the negative effects of ADT in the context of racial differences, specifically comparing African-American men to non-African American men after adjusting for age, comorbidities such as heart disease and established prostate cancer prognostic factors.
"These results show that careful consideration should be taken by physicians when recommending treatment for low or favorable-intermediate prostate cancer, a cancer that very few men die of even without treatment," D'Amico said. "There is no evidence that ADT followed by brachytherapy increases the chance of cure in comparison to other treatments, such an external beam radiation therapy alone, in these men with favorable risk prostate cancer. The subsequent risks of ADT, specifically linked to African-American men, deserve further study."
Future research is indicated to explore the basis for the observation of shortened survival in African-American men following ADT use with the hope of developing effect and personalized treatments for all men with prostate cancer.
Investigators report no funding sources for this research.
Paper cited: Konstantin A. Kovtun, MD; Ming-Hui Chen, PhD; Michelle H. Braccioforte, MPH; Brian J. Moran, MD; Anthony V. D'Amico, MD, PhD. Race and mortality risk following radiation therapy in men treated with or without androgen suppression therapy for favorable-risk prostate cancer. Cancer. doi: 10.1002/cncr.30224.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $600 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation's first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.