Nadine A Friedrich, Jessica L Janes, Joshua Parrish, Amanda M De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P Tatonetti, Stephen J Freedland
{"title":"评估种族差异在退伍军人前列腺癌雄激素剥夺治疗后的后续治疗。","authors":"Nadine A Friedrich, Jessica L Janes, Joshua Parrish, Amanda M De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P Tatonetti, Stephen J Freedland","doi":"10.1038/s41391-025-00995-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2<sup>nd</sup> line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT.</p><p><strong>Methods: </strong>We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates.</p><p><strong>Results: </strong>From 2001-2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2<sup>nd</sup> line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80-0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88-0.98) and Other men (HR = 0.91, 95%CI = 0.84-0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients.</p><p><strong>Conclusions: </strong>All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8000,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing racial differences in time to subsequent treatment following androgen deprivation therapy among Veterans with prostate cancer.\",\"authors\":\"Nadine A Friedrich, Jessica L Janes, Joshua Parrish, Amanda M De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P Tatonetti, Stephen J Freedland\",\"doi\":\"10.1038/s41391-025-00995-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2<sup>nd</sup> line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT.</p><p><strong>Methods: </strong>We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates.</p><p><strong>Results: </strong>From 2001-2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2<sup>nd</sup> line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80-0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88-0.98) and Other men (HR = 0.91, 95%CI = 0.84-0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients.</p><p><strong>Conclusions: </strong>All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.</p>\",\"PeriodicalId\":20727,\"journal\":{\"name\":\"Prostate Cancer and Prostatic Diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2025-07-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Prostate Cancer and Prostatic Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1038/s41391-025-00995-4\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Prostate Cancer and Prostatic Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41391-025-00995-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Assessing racial differences in time to subsequent treatment following androgen deprivation therapy among Veterans with prostate cancer.
Background: For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT.
Methods: We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates.
Results: From 2001-2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2nd line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80-0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88-0.98) and Other men (HR = 0.91, 95%CI = 0.84-0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients.
Conclusions: All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.
期刊介绍：
Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management.
Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis.
Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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