A Dive Into the Data Showing African American Men Do Better Than Caucasian Men with Provenge And All Men Live Longer If They Receive Provenge When Their PSA Scores Are Low

 African American men face many different health disparities with most of the disparities being weighed against them.  There is one notable exception, African American (AA) men have a huge, significant overall survival benefit when given Sipuleucel-T (Provenge) equal to 9.5 months over their Caucasian counterparts!

In the phase III randomized clinical trial (IMPACT) that demonstrated that Sipuleucel -T (Provenge) provided an overall survival benefit, a subgroup analysis hinted that AA men received an even more substantial advantage than Caucasian men.  However, the numbers of AA men in the trial was too small to draw any reliable conclusions. 

After the approval of Provenge, there was a Registry Trial where 1900 men who received Provenge, post its FDA approval were followed.  In the Registry Trial, there were 200 AA men, a much more robust number of men than in the Impact Trial.  

Researchers were able to compare this group of 200 AA men against a PSA matched group of Caucasian men.  

The data showed that the AA men had a median overall survival advantage of 9.5 months over the Caucasian men!  Additional analysis of the data also showed that the overall survival advantage was much more robust in the men who were in the lower two PSA quartiles, with the more significant advantage seen in men who were in the lowest PSA quartile.  Both AA men and Caucasian men in the upper two PSA quartiles received only a minimal benefit from Provenge with neither of the groups (AA and Caucasian) significantly having an overall survival advantage over the other group. 

This is terrific news for everyone, especially AA men, but only if we can get them Provenge when their PSA scores are at the lowest levels.  In reality, both AA men and Caucasian men do better with Provenge when their PSAs are at the lowest levels. 

The take home is that all men should be given Provenge as soon as they become castrate resistant, including AA men.  Provenge at this early stage is a part of the NCCN Guidelines. Therefore, there is NO excuse for doctors not to offer it to men and insurance carriers not to pay for it when a man with prostate cancer becomes castrate resistant.