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.

  • Brief Communication
  • Published:

Clinical

Race-dependent association of clinical trial participation with improved outcomes for high-risk prostate cancer patients treated in the modern era

Prostate Cancer and Prostatic Diseases volume 26, pages 625–627 (2023)Cite this article

Subjects

Abstract

It is unclear whether cancer patients enrolled in clinical trials have improved outcomes compared with non-study patients. We compared prostate cancer-specific mortality (PCSM) in patients in a real-world setting (SEER-Medicare database) versus on a trial (NRG/RTOG 0521). The 7-year freedom from PCSM was superior in trial patients (92.4% vs. 88.1%, sHR = 1.77 [95% CI 1.05–2.97], P = 0.03). Black trial patients had significantly superior freedom from PCSM than Black real-world patients (sHR 6.52, 95% CI 1.43–29.72, P = 0.02), which was not seen among non-Black patients. Trial patients may have improved outcomes, and racial disparities are accentuated in the real world.

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: Freedom from prostate cancer-specific mortality (PCSM) in clinical trial (RTOG 0521) versus real-world (SEER-Medicare) settings.

Similar content being viewed by others

Data availability

Data for these analyses were made available to the authors through agreement with the NRG/Radiation Therapy Oncology Group (RTOG) and the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. As such, the authors cannot make these data publicly available due to data use agreement.

References

  1. Peppercorn JM, Weeks JC, Cook EF, Joffe S. Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review. Lancet. 2004;363:263–70.

    Article  PubMed  Google Scholar 

  2. Rosenthal SA, Hu C, Sartor O, Gomella LG, Amin MB, Purdy J, et al. Effect of chemotherapy with docetaxel with androgen suppression and radiotherapy for localized high-risk prostate cancer: the randomized phase III NRG oncology RTOG 0521 trial. J Clin Oncol. 2019;37:1159–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sandler HM, Karrison T, Sartor AO, Gomella LG, Amin MB, Purdy J, et al. Adjuvant docetaxel for high-risk localized prostate cancer: Update of NRG oncology/RTOG 0521. J Clin Oncol. 2020;38:333.

    Article  Google Scholar 

  4. Chowdhury-Paulino IM, Ericsson C, Vince R Jr., Spratt DE, George DJ, Mucci LA. Racial disparities in prostate cancer among black men: epidemiology and outcomes. Prostate Cancer Prostatic Dis. 2022;25:397–402.

    Article  PubMed  Google Scholar 

  5. 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  PubMed  PubMed Central  Google Scholar 

  6. Ma TM, Romero T, Nickols NG, Rettig MB, Garraway IP, Roach M 3rd, et al. Comparison of response to definitive radiotherapy for localized prostate cancer in black and white men: a meta-analysis. JAMA Netw Open. 2021;4:e2139769.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We acknowledge that this study used the linked SEER-Medicare database and the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

Funding

Funding support for this study comes from the Prostate Cancer Foundation and ASTRO to AUK. AUK also thanks generous donations from the DeSilva, McCarrick, and Bershad families.

Author information

Author notes

  1. These authors contributed equally: Michael Xiang, Amar U. Kishan.

Authors and Affiliations

  1. Department of Radiation Oncology, University of California, Los Angeles, CA, USA

    Ting Martin Ma, Ann C. Raldow, Michael Xiang & Amar U. Kishan

  2. Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA

    Felix Y. Feng

  3. Department of Radiation Oncology, Sutter Medical Group, Roseville, CA, USA

    Seth A. Rosenthal

  4. Department of Urology, University of California, Los Angeles, CA, USA

    Matthew B. Rettig & Amar U. Kishan

  5. Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Matthew B. Rettig

  6. Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Daniel E. Spratt

Authors
  1. Ting Martin Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Felix Y. Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seth A. Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew B. Rettig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ann C. Raldow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel E. Spratt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amar U. Kishan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception: TMM, MX, AUK Data curation: TMM, MX, AUK. Formal Analysis: TMM, MX, AUK. Funding acquisition: AUK Investigation: TMM, FYF, SAR, MBR, ACR, DES, MX, AUK. Project administration: MX, AUK. Supervision: MX, AUK. Writing—original draft: TMM, MX, AUK. Writing—review & editing: TMM, FYF, SAR, MBR, ACR, DES, MX, AUK.

Corresponding author

Correspondence to Amar U. Kishan.

Ethics declarations

Competing interests

AUK reports funding support from grant P50CA09213 from the Prostate Cancer National Institutes of Health Specialized Programs of Research Excellence and grant W81XWH-22-1-0044 from the Department of Defense, as well as grant RSD1836 from the Radiological Society of North America, the STOP Cancer organization, the Jonsson Comprehensive Cancer Center, and the Prostate Cancer Foundation. ACR reports research grant from Intelligent Automation Inc. and Viewray Inc., consulting work for Viewray Inc and Clarity PSO/RO-ILS RO-HAC, honoraria from Clarity PSO/RO-ILS RO-HAC and as a rectal cancer panel member of the Veteran’s Health Administration Radiation Oncology Quality Surveillance Program Services, outside the submitted work. All other authors have no conflict of interest to declare.

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

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, T.M., Feng, F.Y., Rosenthal, S.A. et al. Race-dependent association of clinical trial participation with improved outcomes for high-risk prostate cancer patients treated in the modern era. Prostate Cancer Prostatic Dis 26, 625–627 (2023). https://doi.org/10.1038/s41391-023-00663-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-023-00663-5

Search

Advanced search

Quick links