Evaluation of Survival Outcomes Among Black and White Patients with Metastatic Castration-resistant Prostate Cancer: A Systematic Review and Meta-analysis

Abstract

Context: Data on racial disparities among patients with metastatic castration-resistant prostate cancer (mCRPC) are limited and there is no uniform conclusion on differences by race in this setting.

Objective: To provide the latest evidence on racial disparities in survival outcomes between Black and White patients receiving systemic therapies for mCRPC.

Evidence acquisition: Our study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We systematically searched the PubMed, Web of Science, and Cochrane Library databases up to September 2023 to identify potentially relevant studies. Overall survival (OS) and progression-free survival (PFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were evaluated.

Evidence synthesis: Nine studies involving 9462 patients with mCRPC (2058 Black and 7404 White men) met the eligibility criteria and were included. Pooled estimates demonstrated significantly better OS for Black than for White men (HR 0.75, 95% CI 0.70-0.80; p < 0.0001). The results were similar in a subgroup of men receiving androgen receptor-targeted therapies (HR 0.72, 95% CI 0.66-0.78; p < 0.0001) and a subgroup of men receiving other treatments (HR 0.79, 95% CI 0.71-0.88; p < 0.0001). Likewise, significantly favorable PFS was observed for Black men receiving ARTs in comparison to their White counterparts (HR 0.84, 95% CI 0.71-0.99; p = 0.0373).

Conclusions: Overall, our meta-analysis of survival outcomes for men with mCRPC stratified by race revealed a significant survival benefit for Black men in comparison to their White counterparts, regardless of systemic therapeutic agent.

Patient summary: Both biological and nonbiological factors could account for racial differences in the efficacy of systemic treatments for metastatic prostate cancer that is resistant to hormone therapy. Our review provides the latest reliable evidence showing better survival outcomes for Black than for White men. The results will be helpful in further understanding the molecular mechanisms that might explain racial differences in this disease stage and in planning treatment.

Keywords: African American; Efficacy; Hormone therapy; Metastatic castration-resistant prostate cancer; Race.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow diagram of the study selection process. Reproduced from . mCRPC = metastatic castration-resistant prostate cancer; OS = overall survival; PFS = progression-free survival.

Fig. 2

Forest plot of overall survival for Black and White patients with metastatic castration-resistant prostate cancer across different therapies. ARTs = androgen receptor–targeted therapies; HR = hazard ratio; SE = standard error; IV = inverse variance; CI = confidence interval; df = degrees of freedom.

Fig. 3

Forest plot of progression-free survival for Black and White patients with metastatic castration-resistant prostate cancer receiving androgen receptor–targeted therapies. HR = hazard ratio; SE = standard error; IV = inverse variance; CI = confidence interval; df = degrees of freedom.