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 (BWH), discusses the rationale for investigating the magnitude of racial and ethnic disparities in prostate cancer–specific survival in patients undergoing surgery vs radiotherapy.

Prior research has shown that Black patients experience a higher likelihood of prostate cancer–specific mortality compared with White patients, Cole begins. Moreover, there are clear differences in the use of surgery vs radiotherapy between Black and White patients. White men are more likely to be referred to high-volume cancer surgeons for radiation for prostate cancer and are more likely to meet certain quality metrics for radiotherapy, Cole notes.

However, it was unclear whether those disparities in prostate cancer–specific mortality could be attributed to the relationship between race and treatment modality, or due to variable factors associated with each modality and the frequency of their use in different racial groups, Cole continues. Factors such as a surgeon's expertise and a patient’s disease volume may have a larger and more variable effect on patient outcomes than radiotherapy, which is often more standardized, Cole explains. For example, the increased likelihood of a given racial group to receive surgery vs radiotherapy could negatively affect their outcomes, signaling a larger difference in racial outcomes with one treatment over the other, he states.

To address this unanswered question, a retrospective study compared cancer-specific survival based on race and treatment modality in non-Hispanic Black and non-Hispanic White men with localized intermediate- or high-risk prostate cancer. This study utilized the Surveillance, Epidemiology and End Results (SEER) registry to identify 15,178 Black patients and 60,225 White patients who met the eligibility criteria and were treated with either surgery or radiation between 2004 and 2015. Results from this study presented at the 

2023 American Urological Association Annual Meeting

 showed that Black men were more likely to receive radiotherapy instead of surgery. Furthermore, there were no significant differences in outcomes when comparing Black and White patients treated with surgery or radiation.

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Alexander Putnam Cole, MD, discusses the rationale for investigating the magnitude of racial and ethnic disparities in prostate cancer–specific survival in patients undergoing surgery vs radiotherapy. 
 

Dr Cole on the Rationale for Investigating Race-based Disparities in Prostate Cancer–Specific Survival

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 

 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 

 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 

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 

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.

Alexander Putnam Cole, MD, 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.

Alexander Putnam Cole, MD

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Dr Cole on the Rationale for Investigating Race-based Disparities in Prostate Cancer–Specific Survival

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