Black Men More Likely to Experience MACE After ADT for Prostate Cancer

Black Men More Likely to Experience MACE After ADT for Prostate Cancer

(HealthDay News) — Black patients are more likely to experience adverse cardiovascular outcomes after systemic androgen deprivation therapy (ADT) for prostate cancer, according to a study published online June 18 in JACC: CardioOncology.

Biniyam G. Demissei, M.D., from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues conducted a retrospective cohort study involving 3,543 prostate cancer patients treated with systemic ADT between 2008 and 2021. The multivariable adjusted association between self-reported race (Black versus White) and incident major adverse cardiovascular events (MACE) after initiation of ADT was assessed.

The researchers found that the risk for MACE was increased in association with Black race (hazard ratio, 1.38), with the strongest associations seen for incident heart failure, cerebrovascular disease, and peripheral artery disease (hazard ratios, 1.79, 1.98, and 1.76, respectively). Overall, 98 percent of the disparity in MACE risk between Black and White patients was mediated by the social vulnerability index, specifically the socioeconomic status theme.

“Multilevel targeted interventions tailored to the needs of patients from socioeconomically vulnerable communities are necessary to reduce the disparities in CVD in patients with prostate cancer,” the authors write.

One author disclosed ties to Pfizer.

What is androgen deprivation therapy (ADT)?

Androgen deprivation therapy (ADT), also known as hormone therapy, is a treatment for prostate cancer that aims to starve cancer cells of the fuel they need to grow. Prostate cancer relies on male hormones, called androgens, particularly testosterone, for growth. ADT works by lowering testosterone levels in the body.

This can be achieved through two main ways:

Decreasing testosterone production: This is typically done through a surgical procedure called orchiectomy, where one or both testicles are removed. Testicles are the primary source of testosterone in the body.

Blocking the action of testosterone: Medications called LHRH agonists and antagonists work by essentially tricking the body into stopping testosterone production. Additionally, anti-androgen drugs can directly block testosterone from attaching to receptors on prostate cancer cells, preventing it from signaling growth.

ADT is a common treatment for advanced prostate cancer and can also be used in conjunction with radiation therapy for some localized cancers. While effective, ADT does come with side effects due to lowered testosterone levels, such as hot flashes, fatigue, muscle weakness, and erectile dysfunction.

How does prostate cancer affect Black men?

Prostate cancer poses a significant threat to Black men disproportionately compared to other races.

Black men have a much greater chance of developing prostate cancer. They are 70 percent more likely to be diagnosed than the general population, with one in six Black men facing the disease in their lifetime compared to one in eight white men

Black men are also more likely to be diagnosed with advanced or aggressive prostate cancer. This means the cancer may be faster-growing or have already spread beyond the prostate.

The disparity continues with mortality. Black men are 2.1 times more likely to die from prostate cancer compared to white men.

The reasons for this are complex and still under investigation. Some theories point towards genetics, but social determinants of health likely play a role as well. Limited access to healthcare, lower socioeconomic status, and potential biases in screening and treatment could all contribute.

Due to these factors, organizations like the Prostate Cancer Foundation now recommend Black men consider starting PSA screening discussions with their doctors at a younger age, potentially as early as 40. Early detection and intervention are crucial in improving outcomes for Black men facing prostate cancer.

What are some examples of major adverse cardiovascular events (MACEs)?

Major adverse cardiovascular events (MACEs) are a group of serious heart and blood vessel problems. Researchers use this term to represent a combined outcome in studies, allowing for easier comparison of effectiveness in treatments or risk factors. However, the specific events included in the definition of MACE can vary. These can include stroke, heart failure, cardiovascular death and more.

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