Years of Life Lost From Metastatic Prostate Cancer According to Treatment Era and Race/Ethnicity

Introduction: Randomized trials demonstrated improved survival in metastatic prostate cancer (mPCa) with the adoption of several systemic therapies. However, real-world data validating this effect and quantifying its magnitude in years of life lost (YLL) according to race/ethnicity are unavailable. Methods: In surveillance, epidemiology, and end results (SEER) database (2004–2021), Caucasian, African American, Hispanic, and Asian/Pacific Islander mPCa patients aged 40–80 years treated in androgen deprivation therapy (ADT, 2004–2012), docetaxel (2013–2016), abiraterone (2017–2018), and androgen receptor pathway inhibitor (ARPI, 2019–2021) eras were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). YLL were quantified for mPCa patients and controls. Results: Overall, 36,658 mPCa patients were identified: 22,725 (62.0%) Caucasians, 6956 (19.0%) African Americans, 4785 (13.0%) Hispanics, and 2192 (6.0%) Asians/Pacific Islanders. In the ADT era, YLL values were 10.7 in African Americans, 9.0 in Hispanics, 8.4 in Caucasians, and 6.5 in Asians/Pacific Islanders. In the docetaxel era, YLL values were 9.4 in African Americans, 8.4 in Hispanics, 7.3 in Caucasians, and 6.2 in Asians/Pacific Islanders. In the abiraterone era, YLL values were 8.4 in African Americans, 6.3 in Hispanics, 5.4 in Caucasians, and 4.4 in Asians/Pacific Islanders. In the ARPI era, YLL values were 4.3 in African Americans, 3.6 in Hispanics, 2.7 in Caucasians, and 1.7 in Asians/Pacific Islanders. Conclusion: YLL values decreased with each novel treatment era, in all race/ethnicity groups. The most pronounced decrease in YLL values occurred with the introduction of ARPIs, in all race/ethnicity groups. Despite those survival advances, African Americans were invariably disadvantaged as evidenced by the highest YLL values.