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Effect of Type of Definitive Treatment on Race-Based Differences in Prostate Cancer-Specific Survival - Beyond the Abstract

Racial and ethnic disparities in prostate cancer-specific mortality (PCSM) between non-Hispanic Black and non-Hispanic White men are complex and influenced by various factors.1,2 The existing literature consistently reports race-based differences in both the choice of treatments for high-risk prostate cancer as well as the quality of recommended treatments, including surgery and radiation therapy.3,4 For example, non-Hispanic Black men are more likely to be treated in low-volume centers, by low-volume surgeons, and are less likely to receive minimally invasive surgery, intensity-modulated radiation therapy (IMRT), and care that meets national quality guidelines supported by consortia.5,6 However, it is still unknown whether race-based differences in cancer-specific arise primarily within the different treatment modalities or between the different treatment modalities.

Race-Based Differences Between Treatments: Our study findings align with the existing literature, demonstrating that non-Hispanic Black men were less frequently treated with surgery and had a higher risk of PCSM than non-Hispanic White men. Moreover, we also identified a tendency for treatment with radiation among non-Hispanic Black men which was in a similar direction and magnitude to the difference in PCSM observed between non-Hispanic Black and White men. Race-Based Differences Within Treatments: When we assessed the magnitude of race-based differences in PCSM among subgroups of men treated with surgery or radiation, we found that men receiving the same treatment modality, whether it be surgery or radiation, had no significant race-based differences in PCSM.7

Our findings supported the conclusion that non-Hispanic Black and White men treated with the same treatment modality achieved similar cancer survival outcomes, suggesting the importance of providing equal access to appropriate treatment modalities for all racial and ethnic groups to ensure equitable prostate cancer care and outcomes.

Written by: Nicola Frego, MD, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

References:

  1. Mahal BA, Chen YW, Muralidhar V, et al. Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States. Annals of Oncology. 2017;28(5):1098-1104. doi:10.1093/annonc/mdx041
  2. Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Lin Gomez S. JOURNAL OF CLINICAL ONCOLOGY Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics. J Clin Oncol. 2017;36:25-33.
  3. Wang EH, Yu JB, Abouassally R, et al. Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort. Urology. 2016;95:88-94.
  4. Friedlander DF, Trinh QD, Krasnova A, et al. Racial Disparity in Delivering Definitive Therapy for Intermediate/High-risk Localized Prostate Cancer: The Impact of Facility Features and Socioeconomic Characteristics. Eur Urol. 2018;73(3):445-451.
  5. Kim SP, Boorjian SA, Shah ND, et al. Disparities in access to hospitals with robotic surgery for patients with prostate cancer undergoing radical prostatectomy. Journal of Urology. 2013;189(2):514-520.
  6. Hutten RJ, Weil CR, Gaffney DK, et al. Worsening Racial Disparities in Utilization of Intensity Modulated Radiation Therapy. Adv Radiat Oncol. 2022;7(3):100887.
  7. Frego N, Labban M, Stone B V., et al. Effect of type of definitive treatment on race‐based differences in prostate cancer‐specific survival. Prostate.
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