黑人男性患前列腺癌的发病率和死亡率更高。不清楚精准肿瘤学差异是否影响到具有转移性去势抗癌药物治疗的黑人男性患者。比较黑人和白人患有转移性去势抗癌药物治疗的前列腺癌患者的精准医学数据和预后。本回顾性队列研究使用由前列腺癌精准医学多机构合作项目（PROMISE）联合会收集的数据，该项目是一个多机构登记表及相关临床基因组数据，时间范围为2020年4月至2021年12月。研究对象是具有分子数据的黑人和白人患有转移性去势抗癌药物治疗的患者。数据分析时间为2021年12月至2023年5月。数据库记录了种族和民族信息。主要结局指血浆分子数据的频率，定义为错配修复缺陷（MMRD）或高度微卫星不稳定性（MSI-H），同源重组修复缺陷或肿瘤每兆碱基10个以上的突变负荷。次要结果包括其他变异的频率，进行基因组检测的类型和时机，以及靶向治疗的使用。效果学结果包括前列腺特异性抗原反应率，放射学反应报告和总生存率。共计鉴定出962名符合条件的患有转移性去势抗癌药物治疗的前列腺癌患者，其中包括204名黑人患者（占21.2%，中位数[四分位数]诊断年龄为61 [55-67]岁，131名患者[64.2%]的格利森评分为8-10级，92名患者[45.1%]具有原发性转移性疾病）和758名白人患者（占78.8%，中位数[四分位数]年龄为63 [57-69]岁，445名患者[58.7%]的格利森评分为8-10级，310名患者[40.9%]具有原发性转移性疾病）。自转移性去势抗癌药物治疗开始至后续随访的时间的中位数（四分位数）为26.6 (14.2-44.7)个月。黑人男性进行血浆分子检测的比例更高（111名男性[48.7%]）相较于白人男性（317名男性[36.4%]；P < .001）。两组之间可行的突变比例相似（65名黑人男性[32.8%]；215名白人男性[29.1%]；P = .35），但黑人男性中MMRD或MSI-H的比例比白人男性（18名男性[9.1%]）更高（白人男性为36名男性[4.9%]；P = .04）。黑人男性的PTEN突变较白人男性更少（31名男性[15.7%] vs 194名男性[26.3%]；P = .003），TMPRSS突变也较少（14名男性[7.1%] vs 155名男性[21.0%]；P < .001）。在最常见的15种突变基因中，包括TP53、AR、CDK12、RB1和PIK3CA，没有其他差异。匹配的靶向治疗在黑人男性中较白人男性使用较少（22名男性[33.5%] vs 115名男性[53.5%]；P = .008）。两组之间在靶向治疗的反应或生存率方面没有差异。本转移性去势抗癌药物治疗的队列研究发现，与白人男性相比，黑人男性中MMRD或MSI-H的频率更高，PTEN和TMPRSS的突变频率较低。虽然黑人男性接受靶向治疗的频率较白人男性低，但在临床预后上没有观察到差异。

Black men have higher incidence and mortality from prostate cancer. Whether precision oncology disparities affect Black men with metastatic castration-resistant prostate cancer (mCRPC) is unknown.To compare precision medicine data and outcomes between Black and White men with mCRPC.This retrospective cohort study used data collected by the Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) consortium, a multi-institutional registry with linked clinicogenomic data, from April 2020 to December 2021. Participants included Black and White patients with mCRPC with molecular data. Data were analyzed from December 2021 to May 2023.Database-reported race and ethnicity.The primary outcome was the frequency of actionable molecular data, defined as the presence of mismatch repair deficiency (MMRD) or high microsatellite instability (MSI-H), homologous recombination repair deficiency, or tumor mutational burden of 10 mutations per megabase or greater. Secondary outcomes included the frequency of other alterations, the type and timing of genomic testing performed, and use of targeted therapy. Efficacy outcomes were prostate-specific antigen response rate, site-reported radiographic response, and overall survival.A total of 962 eligible patients with mCRPC were identified, including 204 Black patients (21.2%; median [IQR] age at diagnosis, 61 [55-67] years; 131 patients [64.2%] with Gleason scores 8-10; 92 patients [45.1%] with de novo metastatic disease) and 758 White patients (78.8%; median [IQR] age, 63 [57-69] years; 445 patients [58.7%] with Gleason scores 8-10; 310 patients [40.9%] with de novo metastatic disease). Median (IQR) follow-up from mCRPC was 26.6 (14.2-44.7) months. Blood-based molecular testing was more common in Black men (111 men [48.7%]) than White men (317 men [36.4%]; P < .001). Rates of actionable alterations were similar between groups (65 Black men [32.8%]; 215 White men [29.1%]; P = .35), but MMRD or MSI-H was more common in Black men (18 men [9.1]) than White men (36 men [4.9%]; P = .04). PTEN alterations were less frequent in Black men than White men (31 men [15.7%] vs 194 men [26.3%]; P = .003), as were TMPRSS alterations (14 men [7.1%] vs 155 men [21.0%]; P < .001). No other differences were seen in the 15 most frequently altered genes, including TP53, AR, CDK12, RB1, and PIK3CA. Matched targeted therapy was given less frequently in Black men than White men (22 men [33.5%] vs 115 men [53.5%]; P = .008). There were no differences in response to targeted therapy or survival between the two cohorts.This cohort study of men with mCRPC found higher frequency of MMRD or MSI-H and lower frequency of PTEN and TMPRSS alterations in Black men compared with White men. Although Black men received targeted therapy less frequently than White men, no differences were observed in clinical outcomes.