Years of life lost and mortality rates from metastatic prostate cancer in contemporary African Americans vs. Caucasians

Introduction: It is unknown whether the historical survival disadvantage of African American metastatic prostate cancer (mPCa) patients persists in abiraterone and androgen receptor pathway inhibitors (ARPIs) eras. Methods: In Surveillance, Epidemiology, and End Results (SEER) database (2017–2021), African American and Caucasian mPCa patients aged 40–80 years treated across abiraterone (2017–2018) and ARPI (2019–2021) eras were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). Years of life lost (YLL) were quantified for mPCa patients and controls. Subsequently, propensity score matching (PSM) and multivariable competing-risks regression (CRR) models were used. Results: In abiraterone era, YLL were 8.1 in African Americans vs. 5.4 in Caucasians (Δ: 2.7). In ARPI era, YLL were 4.6 in African Americans vs. 2.6 in Caucasians (Δ: 2.0). The 24-months cancer-specific mortality (CSM) was 30.3% in African Americans vs. 25.4% in Caucasians (multivariable hazard ratio [mHR]: 1.21, p < 0.001) in abiraterone era and 23.3% in African Americans vs. 25.0% in Caucasians (mHR: 1.01, p = 0.8) in ARPI era. The 24-months other-cause mortality (OCM) was 6.6% in African Americans vs. 5.1% in Caucasians (mHR: 1.27, p = 0.039) in abiraterone era and 8.9% in African Americans vs. 5.3% in Caucasians (mHR: 1.87, p < 0.001) in ARPI era. Conclusion: The current data indicate more favorable YLL values exhibited by African Americans in ARPI era relative to abiraterone era, that stand from lower contributions of CSM, but stable contributions of OCM.