Racial Disparities in Survival Outcomes of Prostate Cancer Patients after Surgery for Bone Metastases
- 1 Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
- 2 School of Public Health, University of Texas Health Science Center, Houston, USA
- 3 Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
- 4 Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
- 5 Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
- 6 Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, USA
- 7 Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
- 8 Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, USA
Abstract
Introduction: This study reviewed patients’ demographic, clinical and treatment characteristics to identify prognostic factors associated with survival of prostate cancer after developing bone metastases. We explored the racial disparities in these factors and how they relate with survival. Methods: We conducted a retrospective study on 79 men diagnosed with bone metastasis secondary to prostate cancer who underwent surgery at a single institution from November 1977 to June 2011. Descriptive statistics were used to summarize patients’ characteristics. The Kaplan-Meier method was used to estimate characteristics of the survival distribution using two origination points—diagnosis and surgery. Cox hazard regression explored the relationship between prognostic factors and overall survival. Results: The majority of men were White (n = 63; 80%) followed by Black (n = 7; 9%), Hispanic (n = 7; 9%), and Asian (n = 2; 2%). Multivariate factors associated with poorer survival after bone metastasis surgery included race (Black), Gleason score > 8, and radiation treatment. Patients not receiving radiation had a longer survival experience relative to patients who received radiation before or after surgery (10.3 vs 6.5 months; P = 0.030). There was an association of PSA level at the time of bone metastasis diagnosis with survival following diagnosis but prior to surgery. The median time interval (T m in months) between prostate cancer diagnosis and bone metastasis diagnosis was 39.1 (White), 31.2 (Hispanic), 15 (Blacks) and 43 (Asians). Patients with T m < 35 months had a hazard of death 3 times greater than patients with T m > 35 months (HR = 3.22; P < 0.001). Conclusion: The median survival and time interval from prostate cancer diagnosis to bone metastasis diagnosis was shorter in Blacks with respect to other races. The more aggressive nature of the disease in Blacks is likely due to the biology of the disease rather than access to treatment.
- P. Abrahamsson, “Pathophysiology of Bone Metastases in Prostate Cancer,” European Urology Supplements, Vol. 3, No. 5, 2004, pp. 3-9. doi:10.1016/j.eursup.2004.09.001
- R. E. Coleman, “Metastatic Bone Disease: Clinical Features, Pathophysiology and Treatment Strategies,” Cancer Treatment Reviews, Vol. 27, No. 3, 2001, pp. 165-176. doi:10.1053/ct rv.2000.0210
- D. S. Ernst, J. Hanson and P. M. Venner, “Analysis of Prognostic Factors in Men with Metastatic Prostate Cancer. Uro-Oncology Group of Northern Alberta,” Journal of Urology, Vol. 146, No. 2, 1991, pp. 372-376.
- M. J. Morris and H. I. Scher, “Clinical Approaches to Osseous Metastases in Prostate Cancer,” Oncologist, Vol. 8, No. 2, 2003, pp. 161-173. doi:10.1634/theoncologist.8-2-161
- M. S. Soloway, S. W. Hardeman, D. Hickey, et al., “Stratification of Patients with Metastatic Prostate Cancer Based on Extent of Disease on Initial Bone Scan,” Cancer, Vol. 61, No. 6, 1988, pp. 195-202. doi:10.1002/1097-0142(19880101)61:1 3.0.CO;2-Y
- P. Castro, C. J. Creighton, M. Ozen, et al., “Genomic Profiling of Prostate Cancers from African American Men,” Neoplasia, Vol. 11, No. 3, 2009, pp. 305-312.
- J. C. Cheville, D. Tindall, C. Boelter, et al., “Metastatic Prostate Carcinoma to Bone: Clinical and Pathologic Features Associated with Cancer-Specific Survival,” Cancer, Vol. 95, No. 5, 2002, pp. 1028-1036. doi:10.1002/cncr.10788
- R. M. Hoffman, F. D. Gilliland, J. W. Eley, et al., “Racial and Ethnic Differences in Advanced-Stage Prostate Cancer: The Prostate Cancer Outcomes Study,” Journal of the National Cancer Institute, Vol. 93, No. 5, 2001, pp. 388-395. doi:10.1093/jnci/93.5.388
- I. Thompson, C. Tangen, A. Tolcher, et al., “Association of African-American Ethnic Background with Survival in Men with Metastatic Prostate Cancer,” Journal of the National Cancer Institute, Vol. 93, No. 3, 2001, pp. 219-225. doi:10.1093/jnci/93.3.219
- T. A. Wallace, R. L. Prueitt, M. Yi, et al., “Tumor Immunobiological Differences in Prostate Cancer between African-American and European-American Men,” Cancer Research, 68, No. 3, 2008, pp. 927-936. doi:10.1158/0008-5472.CAN-07-2608
- R. A. Morton Jr., “Racial Differences in Adenocarcinoma of the Prostate in North American Men,” Urology, Vol. 44, No. 5, 1994, pp. 637-645. doi:10.1016/S0090-4295(94)80196-7
- K. J. Pienta and P. S. Esper, “Risk Factors for Prostate Cancer,” Annals of Internal Medicine, Vol. 118, No. 10, 1993, pp. 793-803. doi:10.7326/0003-4819-118-10-199305150-00007