Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Overall survival of black and white men with metastatic castration-resistant prostate cancer (mCRPC): a 20-year retrospective analysis in the largest healthcare trust in England

Prostate Cancer and Prostatic Diseases volume 24, pages 718–724 (2021)Cite this article

Subjects

Abstract

Background

Prostate cancer in black men is associated with poorer outcomes than their white counterparts. However, most studies reporting this disparity were conducted in localized prostate cancer and primarily in the United States.

Methods

Data regarding prostate cancer incidence and mortality for East London between 2008 and 2010 were obtained from the UK National Disease Registration Service. We further evaluated survival outcomes of 425 cases of mCRPC in St Bartholomew’s Hospital, East London, between 1997 and 2016, and analyzed whether ethnicity impacted on responses to different treatment types.

Results

The incidence of prostate cancer in black men was higher than white men in East London. Prostate cancer-specific mortality was proportional to incidence based on ethnic groups. In the detailed analysis of 425 patients, 103 patients (24%) were black (B), and the remainder white (W). Baseline characteristics were comparable in both groups, although black patients had a lower baseline hemoglobin (p < 0.001). Median overall survival for the total cohort was 25.5 months (B) vs 21.8 months (W) (hazard ratio (HR) = 0.81, p = 0.08). There was prolonged survival in the black population in those who only received hormone-based treatment throughout their treatment course; 39.7 months (B) vs 17.1 months (W) (HR = 0.54, p = 0.019).

Conclusion

Black men may do better than white men with mCRPC, in the context of equal access to healthcare. The study also suggests a greater margin of benefit of hormone-based therapy in the black subpopulation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Median overall survival (in months) for total cohort of patients divided by ethnicity.
Fig. 2: Median overall survival (in months) for patients who received chemotherapy during treatment for mCRPC.
Fig. 3: Median overall survival (in months) for patients who did not receive any chemotherapy during treatment for mCRPC.

Similar content being viewed by others

References

  1. Ben-Shlomo Y, Evans S, Ibrahim F, Patel B, Anson K, Chinegwundoh F, et al. The risk of prostate cancer amongst black men in the United Kingdom: the PROCESS cohort study. Eur Urol. 2008;53:99–105.

    Article  Google Scholar 

  2. Evans S, Metcalfe C, Ibrahim F, Persad R, Ben-Shlomo Y. Investigating black-white differences in prostate cancer prognosis: a systematic review and meta-analysis. Int J Cancer. 2008;123:430–5.

    Article  CAS  Google Scholar 

  3. Ellis L, Nyborg H. Racial ethnic variations in male testosterone levels—a probable contributor to group-differences in health. Steroids. 1992;57:72–5.

    Article  CAS  Google Scholar 

  4. Okobia MN, Zmuda JM, Ferrell RE, Patrick AL, Bunker CH. Chromosome 8q24 variants are associated with prostate cancer risk in a high risk population of African ancestry. Prostate. 2011;71:1054–63.

    Article  CAS  Google Scholar 

  5. Presley CJ, Raldow AC, Cramer LD, Soulos PR, Long JB, Yu JB, et al. A new approach to understanding racial disparities in prostate cancer treatment. J Geriatr Oncol. 2013;4:1–8.

    Article  Google Scholar 

  6. Tyson MD II, Castle EP. Racial disparities in survival for patients with clinically localized prostate cancer adjusted for treatment effects. Mayo Clin Proc. 2014;89:300–7.

    Article  Google Scholar 

  7. Wang C, Kamrava M, King C, Steinberg ML. Racial disparity in prostate cancer-specific mortality for high-risk prostate cancer: a population-based study. Cureus. 2017;9:e961.

    PubMed  PubMed Central  Google Scholar 

  8. Thompson I, Tangen C, Tolcher A, Crawford E, Eisenberger M, Moinpour C. Association of African-American ethnic background with survival in men with metastatic prostate cancer. J Natl Cancer Inst. 2001;93:219–25.

    Article  CAS  Google Scholar 

  9. Park HS, Lloyd S, Decker RH, Wilson LD, Yu JB. Limitations and biases of the surveillance, epidemiology, and end results database. Curr Probl Cancer. 2012;36:216–24.

    Article  Google Scholar 

  10. Armstrong AJ, Halabi S, Luo J, Nanus DM, Giannakakou P, Szmulewitz RZ, et al. Prospective multicenter validation of androgen receptor splice variant 7 and hormone therapy resistance in high-risk castration-resistant prostate cancer: the PROPHECY study. J Clin Oncol. 2019;37:1120–9.

    Article  CAS  Google Scholar 

  11. Lloyd T, Hounsome L, Mehay A, Mee S, Verne J, Cooper A. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Med. 2015;13:171.

    Article  Google Scholar 

  12. Gov.UK. Population of England and Wales.

  13. Gov.UK. Regional Ethnic Diversity.

  14. European Association of Urology guideline version 2015. http://www.uroweb.org/guidelines/.

  15. Dess RT, Hartman HE, Mahal BA, Soni PD, Jackson WC, Cooperberg MR, et al. Association of black race with prostate cancer-specific and other-cause mortality. JAMA Oncol. 2019;5:975–83.

    Article  Google Scholar 

  16. Paller CJ, Wang L, Brawley OW. Racial inequality in prostate cancer outcomes-socioeconomics. Not Biol JAMA Oncol. 2019;5:983–4.

    Article  Google Scholar 

  17. McNamara MA GD, et al. Overall survival by race in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate or enzalutamide. J Clin Oncol. 2019;37:212.

    Article  Google Scholar 

  18. Zhao H, Howard LE, De Hoedt A, Terris MK, Amling CL, Kane CJ, et al. Racial discrepancies in overall survival among men treated with (223)Radium. J Urol. 2020;203:331–7.

    Article  Google Scholar 

  19. Dai D, Han S, Li L, Guo Y, Wei Y, Jin H, et al. Anemia is associated with poor outcomes of metastatic castration-resistant prostate cancer, a systematic review and meta-analysis. Am J Transl Res. 2018;10:3877–86.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Ramalingam S, Humeniuk MS, Hu R, Rasmussen J, Healy P, Wu Y, et al. Prostate-specific antigen response in black and white patients treated with abiraterone acetate for metastatic castrate-resistant prostate cancer. Urol Oncol. 2017;35:418–24.

    Article  CAS  Google Scholar 

  21. Edwards A, Hammond HA, Jin L, Caskey CT, Chakraborty R. Genetic variation at five trimeric and tetrameric tandem repeat loci in four human population groups. Genomics. 1992;12:241–53.

    Article  CAS  Google Scholar 

  22. Karakas C, Wang C, Deng F, Huang H, Wang D, Lee P. Molecular mechanisms involving prostate cancer racial disparity. Am J Clin Exp Urol. 2017;5:34–48.

    PubMed  PubMed Central  Google Scholar 

  23. O’Donnell PH, Dolan ME. Cancer pharmacoethnicity: ethnic differences in susceptibility to the effects of chemotherapy. Clin Cancer Res. 2009;15:4806–14.

    Article  Google Scholar 

  24. Lopez RFA, Goel S, Peeke S, Sharma J, Shenoy N. Genomic profiling of prostate cancer at a diverse academic center. J Clin Oncol. 2020;38; abstr. 64.

  25. Ladoire S, Eymard JC, Zanetta S, Mignot G, Martin E, Kermarrec I, et al. Metronomic oral cyclophosphamide prednisolone chemotherapy is an effective treatment for metastatic hormone-refractory prostate cancer after docetaxel failure. Anticancer Res. 2010;30:4317–23.

    CAS  PubMed  Google Scholar 

  26. Shamash J, Jacob J, Agrawal S, Powles T, Mutsvangwa K, Wilson P, et al. Whole blood stem cell reinfusion and escalated dose melphalan in castration-resistant prostate cancer: a phase 1 study. Clin Cancer Res. 2012;18:2352–9.

    Article  CAS  Google Scholar 

  27. Shamash J, Dancey G, Barlow C, Wilson P, Ansell W, Oliver RT. Chlorambucil and lomustine (CL56) in absolute hormone refractory prostate cancer: re-induction of endocrine sensitivity an unexpected finding. Br J Cancer. 2005;92:36–40.

    Article  CAS  Google Scholar 

  28. Belderbos BPS, de Wit R, Hoop EO, Nieuweboer A, Hamberg P, van Alphen RJ, et al. Prognostic factors in men with metastatic castration-resistant prostate cancer treated with cabazitaxel. Oncotarget. 2017;8:106468–74.

    Article  Google Scholar 

  29. Halabi S, Small EJ, Kantoff PW, Kattan MW, Kaplan EB, Dawson NA, et al. Prognostic model for predicting survival in men with hormone-refractory metastatic prostate cancer. J Clin Oncol. 2003;21:1232–7.

    Article  Google Scholar 

  30. Putt M, Long JA, Montagnet C, Silber JH, Chang VW, Kaijun L, et al. Racial differences in the impact of comorbidities on survival among elderly men with prostate cancer. Med Care Res Rev. 2009;66:409–35.

    Article  Google Scholar 

  31. Norman G, Dean ME, Langley RE, Hodges ZC, Ritchie G, Parmar MK, et al. Parenteral oestrogen in the treatment of prostate cancer: a systematic review. Br J Cancer. 2008;98:697–707.

    Article  CAS  Google Scholar 

  32. Venkitaraman R, Thomas K, Huddart RA, Horwich A, Dearnaley DP, Parker CC. Efficacy of low-dose dexamethasone in castration-refractory prostate cancer. BJU Int. 2008;101:440–3.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work uses data that have been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained, and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England (PHE).

Funding

No funding was received specifically for this project. KN is currently funded by a Cancer Research UK Clinical Research Training Fellowship (Award Number 549580).

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Barts Health NHS Trust, London, UK

    Kenrick Ng, Peter Wilson, Katherine Mutsvangwa & Jonathan Shamash

  2. UCL Cancer Institute, University College London, London, UK

    Kenrick Ng

  3. National Cancer Registration and Analysis Service, Public Health England, London, UK

    Luke Hounsome

Authors
  1. Kenrick Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine Mutsvangwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luke Hounsome
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan Shamash
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: KM, LH, and JS. Acquisition of data: KN, PW, and JS. Analysis and interpretation of data: KN, PW, and JS. Drafting of the manuscript: KN and JS. Critical revision of the manuscript for important intellectual content: KN, KM, LH, and JS. Statistical analysis: KN and PW. Supervision: JS.

Corresponding author

Correspondence to Jonathan Shamash.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

Patient outcomes are regularly reviewed in our hospital Trust consistent with the NHS Clinical Governance Framework. In accordance with criteria outlined by the Health Research Authority, NHS Research Ethics Committee approval was not required for this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ng, K., Wilson, P., Mutsvangwa, K. et al. Overall survival of black and white men with metastatic castration-resistant prostate cancer (mCRPC): a 20-year retrospective analysis in the largest healthcare trust in England. Prostate Cancer Prostatic Dis 24, 718–724 (2021). https://doi.org/10.1038/s41391-020-00316-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-020-00316-x

This article is cited by

Search

Advanced search

Quick links