Objectives
To test the effect of race/ethnicity on cancer‐specific mortality after radical prostatectomy or external beam radiotherapy in localized prostate cancer patients.
Methods
In the Surveillance, Epidemiology and End Results database 2004–2016, we identified intermediate‐risk and high‐risk white (n = 151 632), Asian (n = 11 189), Hispanic/Latino (n = 20 077) and African American (n = 32 550) localized prostate cancer patients, treated with external beam radiotherapy or radical prostatectomy. Race/ethnicity‐stratified cancer‐specific mortality analyses relied on competing risks regression, after propensity score matching for patient and cancer characteristics.
Results
Compared with white patients, Asian intermediate‐ and high‐risk external beam radiotherapy patients showed lower cancer‐specific mortality (hazard ratio 0.58 and 0.70, respectively, both P ≤ 0.02). Additionally, Asian high‐risk radical prostatectomy patients also showed lower cancer‐specific mortality than white patients (hazard ratio 0.72, P = 0.04), but not Asian intermediate‐risk radical prostatectomy patients (P = 0.08). Conversely, compared with white patients, African American intermediate‐risk radical prostatectomy patients showed higher cancer‐specific mortality (hazard ratio 1.36, P = 0.01), but not African American high‐risk radical prostatectomy or intermediate‐ and high‐risk external beam radiotherapy patients (all P ≥ 0.2). Finally, compared with white people, no cancer‐specific mortality differences were recorded for Hispanic/Latino patients after external beam radiotherapy or radical prostatectomy, in both risk levels (P ≥ 0.2).
Conclusions
Relative to white patients, an important cancer‐specific mortality advantage applies to intermediate‐risk and high‐risk Asian prostate cancer patients treated with external beam radiotherapy, and to high‐risk Asian patients treated with radical prostatectomy. These observations should be considered in pretreatment risk stratification and decision‐making.