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. 2022 Jan;29(1):17-24.
doi: 10.1111/iju.14701. Epub 2021 Sep 22.

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

Christoph Würnschimmel  1   2 , Mike Wenzel  2   3 , Francesco Chierigo  4 , Rocco Simone Flammia  5 , Zhe Tian  2 , Fred Saad  2 , Alberto Briganti  6 , Shahrokh F Shariat  7   8   9   10   11   12 , Nazareno Suardi  4 , Carlo Terrone  4 , Michele Gallucci  5 , Felix Kh Chun  3 , Derya Tilki  1   13 , Markus Graefen  1 , Pierre I Karakiewicz  2
Affiliations

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

Christoph Würnschimmel et al. Int J Urol. 2022 Jan.

Abstract

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.

Keywords: Epidemiology and End Results; Surveillance; cancer-specific mortality; external beam radiotherapy; localized prostate cancer; other-cause mortality; radical prostatectomy.

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References

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    1. Gray PJ, Lin CC, Cooperberg MR et al. Temporal trends and the impact of race, insurance, and socioeconomic status in the management of localized prostate cancer. Eur. Urol. 2017; 71: 729-37.
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