BACKGROUND: Race/ethnicity may predispose to higher active treatment rates in septuagenarian or older low risk prostate cancer (CaP) patients. We tested this hypothesis within a contemporary North American cohort. MATERIAL AND METHODS: We relied on the Surveillance, Epidemiology and End Results (SEER) database 2010-2016. The effect of race/ethnicity was tested in univariable and multivariable logistic regression analyses predicting definitive treatment administration. Treatment rates (no local treatment [NLT], external beam radiotherapy [EBRT], radical prostatectomy [RP] and brachytherapy) were examined without, as well as with adjustment for age, socioeconomic status, marital status, residence type, year of diagnosis, other-cause mortality, prostate-specific antigen (PSA) and clinical T stage across races/ethnicities. Moreover, temporal trend analyses were performed. RESULTS: Of 15,118 septuagenarian or older low risk CaP patients, 11,509 (76.1%) were Caucasian, 1,613 (10.7%) African-American, 1,293 (8.5%) Hispanic/Latino and 703 (4.7%) Asian. No clinically meaningful differences were recorded between races/ethnicities with respect to age at diagnosis, PSA, clinical T stage and percentage of positive biopsy cores. Conversely, clinically meaningful and statistically significant differences were identified in socioeconomic status and treatment modality. Specifically, treatment rates ranged as follows: NLT 41.8-48.2, EBRT 23.0-29.9, RP 13.8-21.8 and brachytherapy 6.4-9.9% across race/ethnicies. After adjustment for patient and tumor characteristics, NLT, EBRT, RP and brachytherapy rates showed virtually no residual heterogeneity between races/ethnicities. Finally, in temporal trend analyses, EBRT rates decreased in all races/ethnicities. Conversely, RP and brachytherapy rates did not change over time. CONCLUSION: The rates of active treatment in septuagenarian or older low risk CaP patients are surprisingly elevated in all races/ethnicities, even though they decreased over time. All differences in active treatment rates according to race/ethnicity depend on baseline patient and tumor characteristics.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Department of Urology University of Naples Federico 2 Naples Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Division of Experimental Oncology Unit of Urology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada; Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Departments of Urology Weill Cornell Medical College New York NY; Department of Urology University of Texas Southwestern Dallas TX; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia; Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Department of Urology University of Naples Federico 2 Naples Italy

Division of Experimental Oncology Unit of Urology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

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