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 (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.