Dr Cole on Race-Based Differences in Prostate Cancer–Specific Mortality

Alexander Putnam Cole, MD, assistant professor, surgery, Harvard Medical School, associate surgeon, Junior Core Faculty, Center for Surgery and Public Health, Brigham and Women’s Hospital, discusses findings from a study investigating the effect of type of definitive treatment on race-based differences in prostate cancer–specific mortality in patients with prostate cancer.

This study included 15,178 Black patients and 60,225 White patients with localized, intermediate- or high-risk prostate cancer who were treated with either surgery or radiation between 2004 and 2015. The cumulative incidence of prostate cancer–specific mortality was higher in the population of Black patients, with a P value of .005. Additionally, Black patients were found to be less likely to receive surgery as definitive treatment than White patients, with an adjusted odds ratio of 0.53 and a P value of less than .001. These findings indicated that Black men were more likely to experience prostate cancer–specific mortality and more likely to receive radiotherapy instead of surgery, Cole says. Definitive radiation was associated with a higher risk of prostate cancer–specific mortality compared with surgery, with an adjusted hazard ratio (HR) of 2.03 and a P value of less than .001. 

Furthermore, the investigators found that the interaction between race and treatment on prostate cancer–specific mortality was not significant, indicating that race alone did not affect outcomes with surgery or radiation between Black and White patients who received the same treatment modality, Cole explains. No significant differences in prostate cancer–specific mortality were found when comparing Black and White patients treated with surgery or radiation, with adjusted HRs of 1.25 and 0.95, respectively, and P values of .086 and .056, respectively.

When patients with prostate cancer have equal access to treatment options, several racial differences in survival become insignificant, Cole notes. This emphasizes that differences in patient access to care is a key mediator of racial disparities in prostate cancer outcomes, Cole concludes.