Racial Disparities in Survival Outcomes of Prostate Cancer Patients after Surgery for Bone Metastases

Robert L. Satcher, Oluwatosin Bamidele, Patrick Lin, Sue-Hwa Lin, Bryan Moon, Mike Hernandez, Valerae Lewis, Janice Chilton

Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
School of Public Health, University of Texas Health Science Center, Houston, USA.

DOI: 10.4236/jct.2013.44A004                

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.

Keywords

Metastasis; Bone; Prostate Cancer; Racial; Gleason Score

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	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
[2]	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
[3]	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.
[4]	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
[5]	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<195::AID-CNCR2820610133>3.0.CO;2-Y
[6]	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.
[7]	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
[8]	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
[9]	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
[10]	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
[11]	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
[12]	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
[13]	J. L. Stanford, R. A. Stephenson, L. M. Coyle, et al., “Prostate Cancer Trends 1973-1995,” National Cancer Institute, Bethesda, 1999.
[14]	C. M. Tangen, M. H. Hussain, C. S. Higano, et al., “Improved Overall Survival Trends of Men with Newly Diagnosed M1 Prostate Cancer: A SWOG Phase III Trial Experience (S8494, S8894 and S9346),” Journal of Urology, Vol. 188, No. 4, 2012, pp. 1164-1169. doi:10.1016/j.juro.2012.06.046
[15]	T. C. Brand, C. Bermejo, E. Canby-Hagino, et al., “Association of Polymorphisms in TGFB1 and Prostate Cancer Prognosis,” Journal of Urology, Vol. 179, No. 2, 2008, pp. 754-758. doi:10.1016/j.juro.2007.09.020
[16]	A. Berruti, L. Dogliotti, R. Bitossi, et al., “Incidence of Skeletal Complications in Patients with Bone Metastatic Prostate Cancer and Hormone Refractory Disease: Predictive Role of Bone Resorption and Formation Markers Evaluated at Baseline,” Journal of Urology, Vol. 164, No. 4, 2000, pp. 1248-1253. doi:10.1016/S0022-5347(05)67149-2
[17]	R. E. Coleman, “Skeletal Complications of Malignancy,” Cancer, Vol. 80, Suppl. 8, 1997, pp. 1588-1594. doi:10.1002/(SICI)1097-0142(19971015)80:8+<1588::AID-CNCR9>3.0.CO;2-G
[18]	C. S. Galasko, “Skeletal Metastases,” Clinical Orthopaedics and Related Research, Vol. 210, 1986, pp. 18-30.
[19]	J. C. Bailar 3rd, G. T. Mellinger and D. F. Gleason, “Survival Rates of Patients with Prostatic Cancer, Tumor Stage, and Differentiation—Preliminary Report,” Cancer Chemotherapy Reports, Vol. 50, No. 3, 1966, pp. 129-136.
[20]	D. F. Gleason, “Classification of Prostatic Carcinomas,” Cancer Chemotherapy Reports, Vol. 50, No. 3, 1966, pp. 125-128.
[21]	D. F. Gleason, “Histologic Grading and Clinical Staging of Prostatic Carcinoma,” Lea & Febiger, Philadelphia, 1977.
[22]	D. F. Gleason, “Histologic Grading of Prostate Cancer: A Perspective,” Human Pathology, Vol. 23, No. 3, 1992, pp. 273-279. doi:10.1016/0046-8177(92)90108-F
[23]	D. F. Gleason and G. T. Mellinger, “Prediction of Prognosis for Prostatic Adenocarcinoma by Combined Histological Grading and Clinical Staging,” Journal of Urology, Vol. 111, No. 1, 1974, pp. 58-64.
[24]	K. K. Hodge, J. E. McNeal, M. K. Terris and T. A. Stamey, “Random Systematic versus Directed Ultrasound Guided Transrectal Core Biopsies of the Prostate,” Journal of Urology, Vol. 142, No. 1, 1989, pp. 71-74; Discussion 4-5.
[25]	E. Kaplan and P. Meier, “Nonparametric Estimation from Incomplete Observations,” Journal of the American Statistical Association, Vol. 53, No. 282, 1958, pp. 457-481. doi:10.1080/01621 459.1958.10501452
[26]	A. K. Morgans, M. L. Hancock, K. G. Barnette, et al., “Racial Differences in Bone Mineral Density and Fractures in Men Receiving Androgen Deprivation Therapy for Prostate Cancer,” Journal of Urology, Vol. 187, No. 3, 2012, pp. 889-893. doi:10.1016/j.juro.2011.10.136
[27]	D. W. Lin, M. Porter and B. Montgomery, “Treatment and Survival Outcomes in Young Men Diagnosed with Prostate Cancer: A Population-Based Cohort Study,” Cancer, Vol. 115, No. 13, 2009, pp. 2863-2871. doi:10.1002/cncr.24324