External beam radiotherapy [EBRT] and radical prostatectomy [RP] are associated with better survival in Asian PCA patients

[pjoshea13]

New study of SEER data below [1].

"Relative to white patients, an important cancer-specific mortality advantage applies to intermediate-risk and high-risk Asian prostate cancer patients treated with external beam radiotherapy, and to high-risk Asian patients treated with radical prostatectomy. These observations should be considered in pretreatment risk stratification and decision-making."

...

CSM (cancer-specific mortality)

"In high-risk EBRT-treated Asian versus white patients (Fig. 1), respective 10-year CSM rates were 10.4% versus 13.4%, which resulted in a multivariable CRR HR of 0.70 (P < 0.001), showing a decreased risk for Asian patients (Table 2). In intermediate-risk EBRT-treated Asian versus white patients, 10-year CSM rates were 3.0% versus 4.9%, which resulted in a multivariable CRR HR of 0.58 (P < 0.001), showing a decreased risk for Asian patients. In high-risk RP-treated Asian versus white patients, 10-year CSM rates were 4.8% versus 6.7%, which resulted in a multivariable CRR HR of 0.72 (P = 0.04), showing a decreased risk for Asian patients. Conversely, no statistically significant CSM differences were recorded between Asian and white patients in intermediate-risk RP-treated patients"

...

OCM (other-cause mortality)

"In RP patients, Asian patients showed the lowest 10-year OCM rates (7.4%), versus 8.0, 8.4 and 11.2% in Hispanic/Latino, white and African American patients, respectively. Finally, in EBRT patients, Asian patients showed the second lowest 10-year OCM rates (24.1%), after Hispanic/Latino patients (23.1%), versus 10-year OCM rates of 29.0% and 28.3% in white and African American patients, respectively."

-Patrick

[1] Full text: onlinelibrary.wiley.com/doi...

pubmed.ncbi.nlm.nih.gov/345...

Int J Urol

. 2022 Jan;29(1):17-24. doi: 10.1111/iju.14701. Epub 2021 Sep 22.

External beam radiotherapy and radical prostatectomy are associated with better survival in Asian prostate cancer patients

Christoph Würnschimmel 1 2 , Mike Wenzel 2 3 , Francesco Chierigo 4 , Rocco Simone Flammia 5 , Zhe Tian 2 , Fred Saad 2 , Alberto Briganti 6 , Shahrokh F Shariat 7 8 9 10 11 12 , Nazareno Suardi 4 , Carlo Terrone 4 , Michele Gallucci 5 , Felix Kh Chun 3 , Derya Tilki 1 13 , Markus Graefen 1 , Pierre I Karakiewicz 2

Affiliations expand

PMID: 34553428 DOI: 10.1111/iju.14701

Abstract

Objectives: To test the effect of race/ethnicity on cancer-specific mortality after radical prostatectomy or external beam radiotherapy in localized prostate cancer patients.

Methods: In the Surveillance, Epidemiology and End Results database 2004-2016, we identified intermediate-risk and high-risk white (n = 151 632), Asian (n = 11 189), Hispanic/Latino (n = 20 077) and African American (n = 32 550) localized prostate cancer patients, treated with external beam radiotherapy or radical prostatectomy. Race/ethnicity-stratified cancer-specific mortality analyses relied on competing risks regression, after propensity score matching for patient and cancer characteristics.

Results: Compared with white patients, Asian intermediate- and high-risk external beam radiotherapy patients showed lower cancer-specific mortality (hazard ratio 0.58 and 0.70, respectively, both P ≤ 0.02). Additionally, Asian high-risk radical prostatectomy patients also showed lower cancer-specific mortality than white patients (hazard ratio 0.72, P = 0.04), but not Asian intermediate-risk radical prostatectomy patients (P = 0.08). Conversely, compared with white patients, African American intermediate-risk radical prostatectomy patients showed higher cancer-specific mortality (hazard ratio 1.36, P = 0.01), but not African American high-risk radical prostatectomy or intermediate- and high-risk external beam radiotherapy patients (all P ≥ 0.2). Finally, compared with white people, no cancer-specific mortality differences were recorded for Hispanic/Latino patients after external beam radiotherapy or radical prostatectomy, in both risk levels (P ≥ 0.2).

Conclusions: Relative to white patients, an important cancer-specific mortality advantage applies to intermediate-risk and high-risk Asian prostate cancer patients treated with external beam radiotherapy, and to high-risk Asian patients treated with radical prostatectomy. These observations should be considered in pretreatment risk stratification and decision-making.

Keywords: Epidemiology and End Results; Surveillance; cancer-specific mortality; external beam radiotherapy; localized prostate cancer; other-cause mortality; radical prostatectomy.

© 2021 The Authors. International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association.

[Teufelshunde]

I wonder how much of the difference is diet. Asian diet v high fat SAD. Not many plant based white folk out there that I know.

[Javelin18 in reply to Teufelshunde]

I’ve wondered whether lower PCa rates in asian populations is due to them not eating bad things that we eat, or eating good things we don’t eat. With the testing of mushrooms for cancer benefit, researchers seem to be learning towards the second reason.

[CAMPSOUPS in reply to Javelin18]

I lean towards genetics.My wife is only one year younger than me and I look all of my 65 years and then some.

She looks 35 years old.

If my prune face is any indicator of what my organs and biology are doing then my wife with her genetically endowed youthful face is better off.

[pjoshea13 in reply to CAMPSOUPS]

Interestingly:

GGG (Gleason Grade Group)

"Asians showed the most aggressive tumor characteristics of all four race/ethnicity groups. Specifically, median PSA was highest in Asian patients (9.6 ng/mL in EBRT and 6.9 ng/mL in RP), followed by African American patients (9.3 mg/mL in EBRT and 6.6 ng/mL in RP), Hispanic/Latino patients (9.2 ng/mL in EBRT and 6.7 ng/mL in RP) and white patients (7.9 ng/mL in EBRT and 5.9 ng/mL in RP), in that order.

"Also, the highest GGG IV–V rates were recorded in Asians, in both EBRT (32.3%) and RP (21.5%) patients. Conversely, white, Hispanic/Latino and African American EBRT patients showed GGG IV–V of 26.6, 25.3 and 23.8%. In RP patients, these rates were 15.0, 15.8 and 15.1% for white, Hispanic/Latino and African American patients, respectively."

Presumably, higher GGG is due to lower rate of screening. And yet they still did better on CSM & OCM.

-Patrick

[rscic in reply to CAMPSOUPS]

Diet & genetics are usually tough to separate .... in your case diet might be similar. However, aging authorities suggest one of the things one can do to live longer is eat less. Also interestingly, while larger species (whales for example) tend to live longer (probably genetically influenced), within the species, normal but smaller individuals tend to live longer. Lots of confounding factors here but a general trend.

[LearnAll in reply to Teufelshunde]

This is thoughtful idea. Not just ext beam radiation but almost all kind of PCa treatments work better for Asian men. Some of the reasons include life long vegetarian diets with lots of roots, leaves and seeds. Very less meat (in most Asian countries Meat is much more expensive than Vegtables and fruits) , Strong family support and community support...provides emotional stability and increased quest to live. Living outdoors all day, (no A/Cs in homes) , walking many hours a day or riding bicycles and direct exposure to sunlight and fresh air might contribute due to high Vit D3 levels. Asians living in Asia ,particularly in rural area have much less obesity and low rate of Metabolic syndrome.Go to Worldometer website, and you will be surprized that Covid19 death rates are very low compared to western countries. I believe some of the above mentioned factors play role in covid mortality.

[CAMPSOUPS in reply to LearnAll]

I respect and appreciate a lot of your input here so please no offense but I guess I am going to be a bit harsh.

That little whatever it was comment was and for one thing it is racist to some degree. “Asians”.

Using the term Asians rather than being specific to a particular country is a clue to the lack of background you have to be giving the opinion you did.

I don’t know what images you have in your mind but you really built a bridge too far taking hearsay, Westerners myths, and turning it into a pronouncement.

I guess it irks me because people are gullible and you really fed into the perceptions many have.

I lived in Japan for 6 years and returned every 5 to 8 years for a month for many years.

I spent weeks in South Korea, China, Viet Nam, Thailand.

Each country is unique. Not to be lumped into “Asian”.

You need to speak of specific countries. Japanese people have air conditioners and cars.

You seem to be recalling a Viet Nam war movie with peasants riding bicycles and eating bananas and equating it to all of Asia.

The image you portray is everyone in Rickshaws wearing rice hats devouring vegetables. Even in the poorest areas of Viet Nam there is a roadside pork and beef side of the road supplier every ½ mile or so of a quick cheap meal of broth and bones with meat on them. Always plenty of customers.

Meat being expensive is one of the biggest myths no matter whether Japan or other far east countries.

Uncalled for to speak as if you are an expert.

No argument on lack of Covid. Masks are part of the culture for many, many decades. If you wake up with the sniffles you wear a mask on the way to work instead of spreading your cold to others. No politics or whining about mask wearing in Japan and most of the other far east countries.

[pjoshea13 in reply to CAMPSOUPS]

Alas, "Asian" is used in the Seer database & in the paper I cited. With India being in South Asia, I expect that LearnAll identifies as "Asian".

Perhaps I should object to being forced to select the "White" box? Throws me in with a lot of men from different cultures/genetics/cuisines/etc.

[CAMPSOUPS in reply to pjoshea13]

It's been a mess throughout life. Bureaucracies ways/attempts of trying to label race and culture. ha.

[LearnAll in reply to CAMPSOUPS]

Campsoup. Sorry you get offended so easily with a descriptive word "Asian" and start seeing "racism" in it. If we call a glass bottle..a glass bottle...is it "racism" to other type of bottles. No. We use the words purely to describe something. It is not necessarily indicative of racism or discrimination. If my name is Richard..and some one calls me Richard...where is "racism" in it. But when some one's mind is filled with racism and discrimination....everything appears racism to him. In Pjoshuas presenation, the mere purpose is to describe people of Asian region as "Asians" (no racism here ..calm down)

[CAMPSOUPS in reply to LearnAll]

Yea sorry maybe I am a bit thin skinned today. What I was trying to point out doesn't fit with the post and thread.

It's just that:

"Asian" neglects to identify an individual and his or her culture and lumps them all in a category with subsequent perceptions.

Japanese become Chinese. Korean become Japanese. etc.

The "they are all the same" mentality.

[LearnAll in reply to CAMPSOUPS]

In medical science and medical research, we do not go by political differences or enmity between the sub groups in a race. All humans have 99%. similar DNA. In Asian Race, if lumped together all Asian subgroups..they still have a atleast 99.8% or more DNA similar.Political and unique subgroup cultures are not taken into consideration when conducting research because they are not relevant.\ Japanese and Chinese do not like each other but if check their DNA and compare, you will see striking similarity.

In the same way, all caucasians are not exactly similar but mostly similar with minor subgroup differences.

[CAMPSOUPS in reply to LearnAll]

True with DNA.Not true with diet and lifestyle.

[Blackpatch in reply to LearnAll]

With respect, by playing the "racist" card, you're neatly avoided the substance of the comments made about your assertions.

The reality is that "Asian" is to wide a term to allow it to be used in the way you did to conjure up a grab bag of supposed cultural differences that may give rise to medically divergent outcomes.

This is most easily illustrated by looking at the dietary and lifestyle divergence between the two largest Asian countries - China and India. The North Asian/Chinese diet equates most directly to the (potentially positive) factors such as mushrooms and body size that you mention - yet roughly similar numbers of Asians are South Asian, where a fat-heavy diet frequently gives rise to obesity/diabetes, and body size distribution is not materially different to "white" people.

The bottom line is that while there may be some marginal benefit to the analysis presented in the paper (frankly, I doubt it - would any doctor seriously base his decision making on whether or not the patient was Asian??), trying to take the analysis further, in the manner you propose, is just drawing too long a bow.

Of course, I'm an Australian... and everybody knows we're all racists down here, right?

[j-o-h-n]

Rice..........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/11/2022 7:06 PM EST