PURPOSE: To test for differences in cancer-specific mortality (CSM) rates in Hispanic/Latino prostate cancer patients according to treatment type, radical prostatectomy (RP) vs external beam radiotherapy (EBRT). METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2016), we identified 2290 NCCN (National Comprehensive Cancer Network) high-risk (HR) Hispanic/Latino prostate cancer patients. Of those, 893 (39.0%) were treated with RP vs 1397 (61.0%) with EBRT. First, cumulative incidence plots and competing risks regression models tested for CSM differences after adjustment for other cause mortality (OCM). Second, cumulative incidence plots and competing risks regression models were refitted after 1:1 propensity score matching (according to age, PSA, biopsy Gleason score, cT-stage, cN-stage). RESULTS: In NCCN HR patients, 5-year CSM rates for RP vs EBRT were 2.4 vs 4.7%, yielding a multivariable hazard ratio of 0.37 (95% CI 0.19-0.73, p = 0.004) favoring RP. However, after propensity score matching, the hazard ratio of 0.54 was no longer statistically significant (95% CI 0.21-1.39, p = 0.2). CONCLUSION: Without the use of strictest adjustment for population differences, NCCN high-risk Hispanic/Latino prostate cancer patients appear to benefit more of RP than EBRT. However, after strictest adjustment for baseline patient and tumor characteristics between RP and EBRT cohorts, the apparent CSM benefit of RP is no longer statistically significant. In consequence, in Hispanic/Latino NCCN high-risk patients, either treatment modality results in similar CSM outcome.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montréal Health Center Montréal QC Canada

Department of Maternal Child and Urological Sciences Policlinico Umberto 1 Hospital Sapienza Rome University Rome Italy

Department of Surgical and Diagnostic Integrated Sciences University of Genova Genova Italy

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology University Hospital Frankfurt Goethe University Frankfurt Am Main Theodor Stern Kai 7 60590 Frankfurt am Main Germany

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

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

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

See more in PubMed

Emam A, Hermann G, Attwood K, Ji W, James G, Kuettel M, et al. Oncologic outcome of radical prostatectomy versus radiotherapy as primary treatment for high and very high risk localized prostate cancer. Prostate. 2021;81(4):223–230. doi: 10.1002/pros.24089. PubMed DOI PMC

Reichard CA, Nyame YA, Sundi D, Tosoian J, Wilkins L, Alam R, et al. Does time from diagnosis to treatment of high- or very-high-risk prostate cancer affect outcome? BJU Int. 2019;124(2):282–289. doi: 10.1111/bju.14671. PubMed DOI

Tward JD, O’Neil B, Boucher K, Kokeny K, Lowrance WT, Lloyd S, et al. Metastasis, mortality, and quality of life for men with NCCN high and very high risk localized prostate cancer after surgical and/or combined modality radiotherapy. Clin Genitourin Cancer. 2020;18(4):274–283.e5. doi: 10.1016/j.clgc.2019.11.023. PubMed DOI

Tilki D, Chen M-H, Wu J, Huland H, Graefen M, Braccioforte M, et al. Surgery vs radiotherapy in the management of biopsy Gleason Score 9–10 prostate cancer and the risk of mortality. JAMA Oncol. 2019;5(2):213–220. doi: 10.1001/jamaoncol.2018.4836. PubMed DOI PMC

Knipper S, Palumbo C, Pecoraro A, Rosiello G, Tian Z, Briganti A, et al. Survival outcomes of radical prostatectomy vs. external beam radiation therapy in prostate cancer patients with Gleason Score 9–10 at biopsy: a population-based analysis. Urol Oncol. 2020;38(3):79.e9–79.e14. doi: 10.1016/j.urolonc.2019.09.015. PubMed DOI

Chierigo F, Wenzel M, Würnschimmel C, Flammia RS, Horlemann B, Tian Z et al (2021) Survival after radical prostatectomy vs. radiation therapy in high-risk and very high-risk prostate cancer. J Urol. http://www.jurology.com/doi/10.1097/JU.0000000000002250. Accessed 12 Oct 2021 PubMed DOI

U.S. Census Bureau (2019) V2019. Retrieved from https://www.census.gov/quickfacts/fact/table/US/RHI725219#RHI725219. Accessed 15 July 2021

White A, Coker AL, Du XL, Eggleston KS, Williams M. Racial/ethnic disparities in survival among men diagnosed with prostate cancer in Texas. Cancer. 2011;117(5):1080–1088. doi: 10.1002/cncr.25671. PubMed DOI PMC

Chavez-MacGregor M, Unger JM, Moseley A, Ramsey SD, Hershman DL. Survival by Hispanic ethnicity among patients with cancer participating in SWOG clinical trials: cancer survival by Hispanic ethnicity. Cancer. 2018;124(8):1760–1769. doi: 10.1002/cncr.31241. PubMed DOI PMC

Sánchez BE, Aguayo A, Martínez B, Rodríguez F, Marmolejo M, Svyryd Y, et al. Using genetic and epigenetic markers to improve differential diagnosis of prostate cancer and benign prostatic hyperplasia by noninvasive methods in Mexican patients. Clin Genitourin Cancer. 2018;16(4):e867–e877. doi: 10.1016/j.clgc.2018.02.004. PubMed DOI

Moses KA, Orom H, Brasel A, Gaddy J, Underwood W. Racial/ethnic disparity in treatment for prostate cancer: does cancer severity matter? Urology. 2017;99:76–83. doi: 10.1016/j.urology.2016.07.045. PubMed DOI PMC

Porter KR, Hsu J-WY, Chien GW, Xiang AH, Jung H, Chao C, et al. Racial and ethnic differences in time to treatment for patients with localized prostate cancer. Urology. 2013;81(2):283–287. doi: 10.1016/j.urology.2012.11.002. PubMed DOI

About the SEER Program [Internet]. SEER. https://seer.cancer.gov/about/overview.html. Accessed 20 Apr 2021

Mohler JL, Antonarakis ES, Armstrong AJ, D’Amico AV, Davis BJ, Dorff T, et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2019;17(5):479–505. doi: 10.6004/jnccn.2019.0023. PubMed DOI

Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–1474. doi: 10.1245/s10434-010-0985-4. PubMed DOI

Collaborative stage derived AJCC 6th and 7th edition staging. https://seer.cancer.gov/seerstat/variables/seer/ajcc-stage/derived-ajcc.html. Accessed 6 July 2021

RCT (2017) R: a language and environment for statistical computing. https://www.r-projectorg2017. Accessed 15 July 2021

National Cancer Database. http://ncdbpuf.facs.org/. Accessed 05 Jul 2021

Suresh T, Sharma J, Goel S, Kovac E, Gao Q, Gartrell B. Patient characteristics at prostate cancer diagnosis in different races at an academic center serving a diverse population. Clin Genitourin Cancer. 2019;17(2):139–144. doi: 10.1016/j.clgc.2018.12.003. PubMed DOI

Knipper S, Pecoraro A, Palumbo C, Rosiello G, Luzzago S, Tian Z, et al. A 25-year period analysis of other-cause mortality in localized prostate cancer. Clin Genitourin Cancer. 2019;17(5):395–401. doi: 10.1016/j.clgc.2019.07.008. PubMed DOI

Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol. 2011;59(1):88–95. doi: 10.1016/j.eururo.2010.10.003. PubMed DOI

Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203–213. doi: 10.1056/NEJMoa1113162. PubMed DOI PMC

Bernard B, Muralidhar V, Chen Y-H, Sridhar SS, Mitchell EP, Pettaway CA, et al. Impact of ethnicity on the outcome of men with metastatic, hormone-sensitive prostate cancer. Cancer. 2017;123(9):1536–1544. doi: 10.1002/cncr.30503. PubMed DOI PMC

Stranne J, Brasso K, Brennhovd B, Johansson E, Jäderling F, Kouri M, et al. SPCG-15: a prospective randomized study comparing primary radical prostatectomy and primary radiotherapy plus androgen deprivation therapy for locally advanced prostate cancer. Scand J Urol. 2018;52(5–6):313–320. doi: 10.1080/21681805.2018.1520295. PubMed DOI

Abouot SEER-Medicare Linked Database. https://healthcaredelivery.cancer.gov/seermedicare/. Accessed 05 Jul 2021

Bandini M, Preisser F, Nazzani S, Marchioni M, Tian Z, Mazzone E, et al. The effect of other-cause mortality adjustment on access to alternative treatment modalities for localized prostate cancer among African American patients. Eur Urol Oncol. 2018;1(3):215–222. doi: 10.1016/j.euo.2018.03.007. PubMed DOI

Racial/ethnic disparities in the distribution and effect of type and number of high-risk criteria on mortality in prostate cancer patients treated with radiotherapy