SEATTLE — How does Health-Related Quality of Life (HRQoL) after treatment of prostate cancer (PCa) differ for patients of different races? A new military study compared treatment patterns and HRQoL in African American (AA) and non-AA men undergoing active surveillance (AS), radical prostatectomy (RP) or radiation (XRT).
Included were 1,006 men diagnosed with PCa from 2007-2017 in the Center for Prostate Disease Research Database were identified. HRQoL was evaluated using Expanded PCa Index Composite and SF-36 Health Survey. While the study was led by Virginia Mason Franciscan Health, other researchers were from Walter Reed National Military Medical Center, the Uniformed Services University of the Health Sciences and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., all in Bethesda, MD, as well as 6Madigan Army Medical Center in Tacoma, WA; the Naval Medical Center in San Diego; the Tripler Army Medical Center in Honolulu and Brooke Army Medical Center, Fort Sam Houston in Houston.
Results were published in Prostate Cancer & Prostatic Diseases. Of the patients with localized PCa, 223 (22.2%) were AA (mean follow-up 5.2 years). The results indicated that AA men with low-risk disease were less likely to undergo AS (28.5 vs. 38.8%) and more likely to undergo XRT (22.3 vs. 10.6%) than non-AA men, p <0.001.1
In intermediate-risk disease, meanwhile, AA received more XRT (43.0 vs. 26.9%) and less RP (50.5 vs 66.8%), p = 0.016. Researchers pointed out that, in all patients, RP resulted in worse urinary function and sexual HRQoL compared to AS and XRT.
“Bowel HRQoL did not vary by treatment in AA men, however, in non-AA men, XRT resulted in worse bowel scores than AS and RP,” the researchers wrote. “HRQoL was then compared for each treatment modality. AA men had worse sexual bother (p = 0.024) after RP than non-AA men, No racial differences were found in urinary, bowel, hormonal, or SF-36 scores for men undergoing AS, RP or XRT.”
The study authors concluded that AA men are less often treated with AS for low-risk disease and are more likely to undergo XRT. “AA men experience worse sexual bother after RP, however, the effect of XRT on bowel symptoms is worse in non-AA men,” they advised.
- Posielski NM, Shanmuga S, Ho O, Jiang J,et. al. The effect of race on treatment patterns and subsequent health-related quality of life outcomes in men undergoing treatment for localized prostate cancer. Prostate Cancer Prostatic Dis. 2022 Nov 10. doi: 10.1038/s41391-022-00608-4. Epub ahead of print. PMID: 36357592.
