Recurrent Prostate Cancer After Radiation Therapy: Lethality and Treatment Among Black and White Men in an Equal Access Health System
Abstract
Rationale: Over 75,000 men—almost half of all patients diagnosed each year in the U.S. with prostate cancer—undergo radiation treatment. Radiation is very effective in curing prostate cancer. However, in up to 40% of those treated with radiation, the cancer will eventually return. These men are at risk of dying from prostate cancer. Yet relatively little is known about radiation-resistant prostate cancer, particularly about Black patients who develop it. Black patients are more likely to die from prostate cancer in general. Increased knowledge about radiation-resistant prostate cancer may lead to improved treatments for enhancing the quality of life and reducing the risk of death in these patients. Objectives: We will study radiation-resistant prostate cancer in a national database of over 1 million U.S. Veterans who received their care in the Veterans Affairs (VA) Health System. We will focus on a group of 35,000 Veterans with prostate cancer, approximately 30% of whom are Black men. We will describe how often radiation-resistant prostate cancer occurs in Black and White men, identify risk factors for developing it, and distinguish features that place some patients at increased risk of dying from it. We will also study treatments for radiation-resistant prostate cancer, including observation, hormone therapy, surgery, cryoablation (a form of cold-based ablation), high-intensity focused ultrasound (or HIFU, a form of heat-based ablation), and radiation. We will determine which of these treatments have the highest potential to improve quality of life and prevent death in patients with radiation-resistant prostate cancer. In all of these analyses, we will explore potential differences in outcomes between Black and White patients. Aims: There are three main goals of this proposal. First, we intend to identify current treatments that are the most effective for radiation-resistant prostate cancer. We believe that further characterization of these treatments—observation, hormone therapy, surgery, cryoablation, HIFU, and radiation—will pinpoint those with the most potential to maximize quality of life and decrease death. Second, we intend to improve understanding of the prognosis of Black men with radiation-resistant prostate cancer and, more broadly, to further elucidate why Black men are more likely to die from prostate cancer than other racial groups. Finally, though improved understanding of patient risk factors for radiation resistance, we intend to provide insights into its biology that may lead to new and improved treatments. Applicability and Potential Contributions: Radiation-resistant prostate cancer is a lethal form of prostate cancer. Our proposal has the potential to provide actionable information within 2 years. This information will include (1) the first-ever, large-scale description of radiation-resistance among Black patients, which may provide a road map for preventing death in these patients; (2) detailed observations of the most effective therapies for treating radiation-resistance; and (3) elucidation of possible strategies to reduce prostate cancer death among Veterans and the general population. In the longer term, our proposal may provide critical insights into the biology of radiation-resistant prostate cancer. These insights may lead to new treatments, better methods of diagnosis, and improved understanding of the molecular causes of lethal prostate cancer. In addition, we anticipate that our proposed Community Advisory Board will allow us to partner and engage with the Black community to improve the care of Black men with prostate cancer through constructive, honest, and transparent dialogue.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110955
Entities
People
- Brent S Rose
Organizations
- United States Army
- University of California, San Diego