Prostate Cancer Outcomes Differ by Race

Black and White patients treated for localized prostate cancer received secondary treatment at similar overall rates, but mortality differed among those who did not receive secondary treatment, according to a cohort study published in JAMA Network Open.

Investigators used Surveillance, Epidemiology, and End Results–Medicare data from 83,156 non-Hispanic Black and White men aged 66 years or older who were diagnosed with localized prostate cancer from 2004 through 2017. Participants received definitive treatment within 12 months of diagnosis and were divided into cohorts based on initial treatment: surgery in 22,271 patients and radiation therapy in 60,885. Secondary treatment was defined as treatment received more than 1 year after primary treatment.

Secondary treatment was received by 17.6% of Black patients and 19.3% of White patients in the surgery cohort, a difference that was not statistically significant. Corresponding rates in the radiation cohort were 26.5% and 28.2%. Among patients who received secondary treatment, prostate cancer–specific and all-cause mortality did not differ significantly by race.

Among patients who did not receive secondary treatment after surgery, however, Black patients had higher adjusted risks of prostate cancer–specific mortality (hazard ratio [HR], 2.07) and all-cause mortality (HR, 1.47). Similar differences were found after primary radiation therapy, with respective HRs of 1.59 and 1.33. Secondary-treatment type also differed by race. Relative to androgen deprivation therapy (ADT) alone, Black patients were less likely to receive several radiation or systemic treatment approaches.

The investigators cautioned that the time-based cutoff used to identify secondary treatment could have caused misclassification and that residual confounding remained possible. Available data also did not establish whether secondary treatment was clinically indicated for individual patients. The authors said the findings raise concerns about potential inequities in secondary care and warrant further investigation of factors influencing follow-up treatment.

Source: Acolin J, Zhao Y, Holt SK, et al. Racial differences in secondary treatment pathways and survival in localized prostate cancer. JAMA Netw Open. 2026;9(7):e2624155. doi:10.1001/jamanetworkopen.2026.24155