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Brachytherapy Results Similar for Blacks, Whites

Brachytherapy Results Similar for Blacks, Whites

CHICAGO—Black men with localized prostate cancer do just as well as white
men when treated with brachy-therapy alone, William Barrett, MD, said at the
88th Annual Scientific Assembly of the Radiological Society of North America
(RSNA abstract 252RO-p).

Mortality from prostate cancer is more than two times higher for black men
than it is for men from any other ethnic group. It has long been
controversial whether this high mortality rate is because the disease is
biologically more aggressive and therefore less curable in black men or
because the diagnosis and treatment of prostate cancer are delayed in this
patient population, said Dr. Barrett, assistant professor of radiation
oncology and otolaryngology, Head and Neck Surgery, University of Cincinnati
Hospital.

Several studies over the last few years have compared the outcomes of
black and white American men treated with radical prostatectomy or external
beam radiation therapy for prostate cancer, and those studies found that,
stage for stage, the prognosis following surgery or radiotherapy was similar
for the two ethnic groups, he said.

According to findings from a study conducted by Dr. Barrett, the same
holds true for black and white men who were treated with radiation seed
implantation. There was no difference in the number of recurrences after
treatment or in the number of individuals who achieved and maintained nadir
levels of prostate-specific antigen (PSA) that are indicative of disease-free
status.

Dr. Barrett and his co-author William M. Kassing, PhD, compared outcomes
among 173 men (12 black and 161 white) who were implanted with iodine 125
seeds for localized adenocarcinoma of the prostate between July 1995 and
October 2001. Men in both groups had a similar stage of disease. The median
Gleason score for each group was 6; median pretreatment PSA levels were 8.0
ng/mL and 6.0 ng/mL for black and white men, respectively. None of the
patients had palpable extraprostatic disease at the time of treatment, and
none received other hormonal therapy, surgery, or external beam radiotherapy
for prostate cancer.

In 44 months of follow-up, none of the black men suffered a recurrence vs
5.6% of whites with 40 months of follow-up (P = .28). The percentage
of men who achieved and maintained low PSA levels was similar in both groups:
83% of blacks and 85% of whites had a PSA of 1.0 ng/mL or less (P =
.43); 67% of blacks and 72% of whites had PSA of 0.5 ng/mL or less, (P =
.34); and 50% of blacks and 44% of whites had PSA of 0.2 ng/mL or less (P
=
.35).

"We found no difference in outcome between African-Americans and
Caucasians by each of those definitions of disease freedom," Dr. Barrett
said. He added that the findings have implications for the debate over the
value of PSA screening, which may detect slow-growing disease that will never
be an issue for the patient.

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