Racial influence on biochemical disease-free survival in men treated with external-beam radiotherapy for localized prostate cancer

Background: We retrospectively analyzed the clinical characteristics and outcomes of various racial and ethnic groups who underwent radiotherapy alone for localized or locally advanced prostate cancer. Methods: From April 1987 to January 1998, 964 patients underwent full-dose, external-beam radiotherapy alone for localized or locally advanced prostate cancer and were included in the study. The patients' medical records were reviewed for pertinent information. Results: Of the 964 patients, 810 were non-Hispanic white, 86 were African-American, 54 were Hispanic, and 14 were Asian. The most significant difference between groups was in the proportion of patients who presented with initial PSA levels >20 ng/ml. More than 20% of men in all minority groups presented with a serum PSA >20 ng/ml, compared to only 11% of whites (p=0.0012). Similady, 14% of minorities presented with Gleason scores ≥8 compared to only 11% of whites (p=0.0265). Hispanic and Asian patients exhibited a higher incidence of Gleason score ≥8 prostate cancer. When comparing the time intervals of 1995-1998 vs. 1987-1994, the number of men presenting for EBRT with PSA levels <10 ng/ml increased to 74% from 57% for Caucasians (p<0,001), 71% from 40% for African Americans (p=0.012), 67% from 49% for Hispanics (p=0.1181, and no change (50%) for Asians. Conclusions: The number of African-American patients presenting with favorable characteristics (PSA <10 ng/ml) is increasing. These findings suggest that the message of screening and early detection may be reaching the African-American community. Continued diligence in screening and early detection may improve prostate cancer outcome for other minority populations.