Black men have a higher prevalence of and mortality rate from
prostate cancer compared with White men and have been shown to present with more aggressive and later-stage disease. How
prostate cancer treatment affects these racial disparities is still unclear. Several studies have shown that Black men who receive treatment have a more pronounced decrease in
prostate cancer-specific death; however, there remains a large disparity in all-cause mortality. This disparity may be in part related to a higher risk of death resulting from comorbidities, given the higher rates of
cardiovascular disease and diabetes in Black men, both of which are complicated by the use of
androgen-deprivation
therapy. To further understand these disparities, it is important that we analyze the racial differences in adverse event rates and severity. Increasing the percentage of Black men in clinical trials will improve the understanding of the biologic drivers of racial disparities in
prostate cancer. To evaluate the potential differences in adverse event reporting and demonstrate the feasibility of enrolling equal numbers of Black and White men in trials, we performed a prospective, multicenter study of
abiraterone plus
prednisone with
androgen-deprivation
therapy in men with metastatic
castration-resistant
prostate cancer, stratified by race. Racial differences in
prostate-specific antigen kinetics and toxicity profile were demonstrated. Higher rates and severity of adverse events related to adrenal
hormone suppression, including
hypertension,
hypokalemia, and hypomagnesemia, were seen in the Black cohort, not previously reported. Increased enrollment of Black men in
prostate cancer clinical trials is imperative to further understand the impact of race on clinical outcomes and treatment tolerability.