title: Race and survival following brachytherapy-based treatment for men with localized or locally advanced adenocarcinoma of the prostate.
abstract: OBJECTIVE
  We investigated whether race was associated with risk of death following brachytherapy-based treatment for localized prostate cancer, adjusting for age, cardiovascular comorbidity, treatment, and established prostate cancer prognostic factors.
  
  
  METHODS
  The study cohort was composed of 5,360 men with clinical stage T1-3N0M0 prostate cancer who underwent brachytherapy-based treatment at 20 centers within the 21st Century Oncology consortium. Cox regression multivariable analysis was used to evaluate the risk of death in African-American and Hispanic men compared to that in Caucasian men, adjusting for age, pretreatment prostate-specific antigen (PSA) level, Gleason score, clinical T stage, year and type of treatment, median income, and cardiovascular comorbidities.
  
  
  RESULTS
  After a median follow-up of 3 years, there were 673 deaths. African-American and Hispanic races were significantly associated with an increased risk of all-cause mortality (ACM) (adjusted hazard ratio, 1.77 and 1.79; 95% confidence intervals, 1.3-2.5 and 1.2-2.7; p < 0.001 and p = 0.005, respectively). Other factors significantly associated with an increased risk of death included age (p < 0.001), Gleason score of 8 to 10 (p = 0.04), year of brachytherapy (p < 0.001), and history of myocardial infarction treated with stent or coronary artery bypass graft (p < 0.001).
  
  
  CONCLUSIONS
  After adjustment for prostate cancer prognostic factors, age, income level, and revascularized cardiovascular comorbidities, African-American and Hispanic races were associated with higher ACM in men with prostate cancer. Additional causative factors need to be identified.
authors.affiliation: Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA. kwinkfield@partners.org
authors.forename: Karen M
authors.initials: KM
authors.lastname: Winkfield
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Dosoretz
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Salenius
authors.forename: Michael
authors.initials: M
authors.lastname: Katin
authors.forename: Rudi
authors.initials: R
authors.lastname: Ross
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D044383:Black People; D001918:Brachytherapy / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People; D001741:Black or African American
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen