External beam radiotherapy and radical prostatectomy are associated with better survival in Asian prostate cancer patients

• Published in: International journal of urology Vol. 29; no. 1; pp. 17 - 24
• Main Authors: Würnschimmel, Christoph, Wenzel, Mike, Chierigo, Francesco, Flammia, Rocco Simone, Tian, Zhe, Saad, Fred, Briganti, Alberto, Shariat, Shahrokh F, Suardi, Nazareno, Terrone, Carlo, Gallucci, Michele, Chun, Felix KH, Tilki, Derya, Graefen, Markus, Karakiewicz, Pierre I
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.01.2022
• Subjects: African Americans; Black or African American; cancer‐specific mortality; Decision making; Epidemiology; Epidemiology and End Results; Ethnicity; external beam radiotherapy; Hispanic Americans; Humans; localized prostate cancer; Male; Minority & ethnic groups; Mortality; other‐cause mortality; Prostate; Prostate cancer; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiation therapy; radical prostatectomy; Surveillance; Epidemiology and End Results; external beam radiotherapy; localized prostate cancer; other-cause mortality; radical prostatectomy; Surveillance; cancer-specific mortality
• ISSN: 0919-8172; 1442-2042; 1442-2042
• DOI: 10.1111/iju.14701

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.