SECONDARY treatment following definitive therapy for localised prostate cancer was received at similar rates by Black and White patients, but important differences in survival remained among those who did not receive additional treatment, according to a large population-based cohort study.
Black men are more than twice as likely to die from prostate cancer than White men, yet the factors contributing to this disparity remain incompletely understood. Researchers therefore examined whether treatment pathways after definitive primary therapy differed by race and whether these differences were associated with mortality outcomes.
The retrospective cohort study analysed data from the Surveillance, Epidemiology, and End Results Medicare database, including non Hispanic Black and White men aged 66 years or older diagnosed with localised prostate cancer between 2004–2017. Participants were grouped according to whether they initially received surgery or radiation therapy to improve comparisons between treatment cohorts. Secondary treatment was defined as any treatment received more than 1 year after primary therapy.
The analysis included 83,156 patients. Among those who underwent primary surgery, 22,271 patients were evaluated, including 1,312 Black patients and 20,959 White patients. Secondary treatment was received by 4,275 patients, representing 19.2% of this cohort, with no significant differences between racial groups.
Among the 60,885 patients who received primary radiation therapy, including 6,052 Black patients and 54,833 White patients, 17,058 patients, or 28.0%, received secondary treatment. Again, no significant racial differences were observed in the likelihood of receiving secondary treatment.
Mortality outcomes were also similar between Black and White patients who received secondary treatment following either surgery or radiation therapy.
A different pattern emerged among patients who did not receive secondary treatment. In both the surgery and radiation therapy cohorts, Black patients experienced a higher risk of both prostate cancer specific mortality and all cause mortality than White patients.
Secondary analyses also suggested that the type of secondary treatment differed according to race, including the use of secondary radiation therapy, androgen deprivation therapy, and novel systemic therapies.
The authors concluded that while receipt of secondary treatment did not differ between Black and White patients with localised prostate cancer, persistent survival disparities among patients who did not receive additional treatment raise concerns about inequities in healthcare access and quality. They suggested these findings highlight the importance of understanding treatment pathways after definitive therapy and identifying opportunities to improve equitable prostate cancer care.
Acolin J et al. Racial differences in secondary treatment pathways and survival in localized prostate cancer. JAMA Netw Open. 2026;9;(7):e2624155.
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