The largest clinical genomic profiling study of non-Hispanic Black men with metastatic prostate cancer to date has revealed critical biological differences between racial groups while demonstrating that equal access to care can lead to comparable survival outcomes regardless of race.
Researchers from Moffitt Cancer Center, University of Pennsylvania, University of California Los Angeles, and the Veterans Affairs (VA) National Precision Oncology Program analyzed data from more than 5,000 U.S. veterans with metastatic prostate cancer who underwent next-generation sequencing between 2019 and 2023. The groundbreaking study was published in JAMA Network Open.
Key Genomic Differences Identified
The research team discovered significant variations in tumor biology between non-Hispanic Black and non-Hispanic white veterans. Most notably, Black veterans were significantly more likely to have genomic alterations associated with potential immunotherapy benefit, such as microsatellite instability.
In contrast, white veterans demonstrated higher rates of mutations in DNA repair genes and the androgen receptor axis, which may influence how patients respond to hormonal therapies commonly used in prostate cancer treatment.
"These results affirm that precision oncology can be a powerful tool for achieving equitable cancer care," said Dr. Kosj Yamoah, senior author and chair of the Radiation Oncology Program at Moffitt. "By using genomic testing to guide therapy selection, we can match patients to treatments based on their tumor biology, not race."
Equal Access Leads to Equal Outcomes
Perhaps the most significant finding was that despite these biological differences, survival outcomes were comparable between racial groups within the equal-access VA healthcare system. This suggests that when barriers to care are removed and precision medicine approaches are applied equitably, outcome disparities can be minimized.
Dr. Isla Garraway, co-senior author and director of research in the Urology Department at UCLA Health, emphasized the implications: "This research reinforces that we must not let historical disparities define modern care. Instead, by prioritizing access to genomic tools, we can drive meaningful change in how prostate cancer is treated across all populations."
Implications for Precision Medicine
The study identified several other important findings:
- Tumor suppressor gene alterations were linked to worse survival in both racial groups
- No biomarkers were identified that should be excluded from testing based on race
- The study's diverse cohort, with 36% non-Hispanic Black veterans, represents a significant improvement in inclusion compared to previous genomic studies
Dr. Kara Maxwell, co-senior author and assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine, noted, "This study shows that when we remove barriers to care and apply precision medicine equitably, we can improve outcomes for all patients."
Addressing Historical Disparities
Prostate cancer has long shown racial disparities in both incidence and outcomes. Black men in the United States have approximately 1.5 times the incidence rate of prostate cancer compared to white men and are more than twice as likely to die from the disease.
These disparities have been attributed to multiple factors, including socioeconomic barriers, access to healthcare, and potential biological differences. This study helps clarify which factors may be biological versus social in nature.
Future Directions
The researchers emphasized the importance of continuing to broaden access to next-generation sequencing testing and ensuring that underrepresented groups are included in precision oncology research and clinical trials.
The study was supported by the National Cancer Institute (P30-CA076292), the Prostate Cancer Foundation (PCF22CHAL02), and the VA National Precision Oncology Program.
As genomic testing becomes more widespread, findings from this study could help guide more personalized treatment approaches for metastatic prostate cancer patients across all racial and ethnic groups, potentially reducing long-standing disparities in cancer outcomes.
