Prostate Cancer Pain Tied to Risk of Death and Differs by Race

Black patients with prostate cancer report worse pain than their White peers, and more severe pain is associated with a higher risk of death, according to a study published in Cancer Research Communications.

The study included 879 patients with newly diagnosed prostate cancer who were enrolled in the International Registry for Men with Advanced Prostate Cancer (IRONMAN) at 38 US sites (ClinicalTrials.gov Identifier: (NCT03151629).

Most patients (65%) had metastatic hormone-sensitive prostate cancer (mHSPC), and 35% had castration-resistant prostate cancer (CRPC). Eighty percent of patients identified as White, and 20% identified as Black.

Disease characteristics were generally similar by race, but Black patients had a higher baseline prostate-specific antigen level than White patients. For all patients, the most common treatments were androgen deprivation therapy (89%), androgen receptor signaling inhibitors (67%), and chemotherapy (24%).

Black patients tended to have more severe baseline pain than White patients. On the EORTC QLQ-C30 Pain Scale (0-100), the mean pain score was 28.1 in Black patients with CRPC and 23.1 in White patients with CRPC (P =.05). Among patients with mHSPC, the mean score was 26.7 in Black patients and 25.0 in White patients (P =.03).

On the Brief Pain Inventory, the mean pain score (1-10) was 2.2 in Black patients with CRPC and 1.6 in White patients with CRPC (P =.01). Among patients with mHSPC, the mean pain score was 2.4 in Black patients and 1.6 in White patients (P <.001).

However, there was no significant difference in bone pain between Black and White patients (P =.27).

The researchers also found that more severe pain at baseline was associated with an increased risk of death from any cause. In a fully-adjusted model, a higher risk of death was seen with:

• Higher scores on the EORTC scale (hazard ratio [HR], 1.10; 95% CI, 1.03-1.17)
• Higher average pain on a scale of 1 to 10 (HR, 1.19; 95% CI, 1.08-1.32)
• Worst pain on a scale of 1 to 10 (HR, 1.16; 95% CI, 1.08-1.25)
• Some bone pain vs none (HR, 1.61; 95% CI, 1.10-2.37)
• A lot of bone pain vs none (HR, 2.47; 95% CI, 1.44-4.22).

“Black participants experienced substantially higher pain at study enrollment compared to White participants, and more pain is associated with higher mortality independent of covariates related to disease burden,” the researchers concluded. “Our analysis highlights the need for further investigation of the experience and management of pain in this population in addition to the biologic drivers of the association between pain and mortality to improve survivorship, particularly for Black individuals experiencing the most severe pain and highest prostate cancer mortality.”

Disclosures: The International Registry for Men with Advanced Prostate Cancer is funded by Amgen, AstraZeneca, Astellas, Bayer, Janssen, Merck, and Sanofi.

This article originally appeared on Cancer Therapy Advisor