Although Black men presented with more aggressive localized prostate cancer, they experienced better outcomes than White men when treated with definitive radiotherapy (RT), according to a meta-analysis published in JAMA Network Open.

The meta-analysis included data from 8814 patients enrolled in 7 randomized clinical trials evaluating definitive RT, with or without androgen-deprivation therapy, between 1990 and 2010. The median follow-up was 10.6 years.

The patients had a mean age of 69.1 years, and 18.5% were Black. Most patients had intermediate-risk disease (48.4%) or high-risk disease (34.3%) according to National Comprehensive Cancer Network criteria.

The diagnosis of prostate cancer among Black men occurred at a significantly younger age than among White men. The median age was 68 years and 71 years, respectively (P <.001).

Black men were also more likely to present with high-risk disease (P <.001), higher prostate-specific antigen levels (P <.001), and Gleason scores of 8 to 10 (P =.03).

However, Black men had better outcomes than White men. In a multivariable analysis, Black race was significantly associated with lower rates of biochemical relapse (subdistribution hazard ratio [sHR], 0.79; 95% CI, 0.72-0.88; P <.001), distant metastases (sHR, 0.69;95% CI, 0.55-0.87; P =.002), and prostate cancer-specific mortality (sHR, 0.68; 95% CI, 0.50-0.93; P =.01).

“These results provide high-level evidence to question the belief that prostate cancer among Black men necessarily portends a worse prognosis compared with White men,” the researchers wrote. They added that these data suggest that “other determinants of outcome, such as access to care, are important factors of achieving racial equality.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Ma TM, Romero T, Nickols NG, et al. Comparison of response to definitive radiotherapy for localized prostate cancer in Black and White men. A meta-analysis. JAMA Netw Open. 2021;4:e2139769. doi:10.1001/jamanetworkopen.2021.39769