Race is not prognostic in unfavorable prostate cancer: an NCDB analysis

Supplemental Digital Content is available in the text. Introduction: It is commonly held that race serves as a significant prognosticator in prostate cancer. We sought to analyze whether race impacted overall survival (OS) of men receiving standard of care treatment. Materials and Methods: All data was obtained from the NCDB (National Cancer Database) and initially contained 1,294,126 cases of prostate cancer diagnosed between 2004 and 2013. Patients were excluded if they had metastatic or nodal disease, received chemotherapy, or had noninvasive disease. Patients were grouped into 2 cohorts as per NCCN (National Comprehensive Cancer Network) criteria: favorable risk and unfavorable risk. All patients received risk-appropriate radiation therapy or surgery, and were subsequently analyzed. Black and white men were also matched 1:1 within each risk cohort using propensity scores, and multivariate analysis was conducted on these matched cohorts. Results: The final cohort 77,448 patients. Median follow-up 58.7 months (range, 48–143.5). In the favorable risk cohort, white men had superior OS compared with black men, 77.63% versus 80.57% at 10 years (hazard ratio, 0.644; 95% confidence interval, 0.536–0.773; P<0.001). In the unfavorable cohort, race was not a significant prognostic factor for OS on unmatched analysis; 10-year survival 73.6% and 71.3% (hazard ratio, 0.941; 95% confidence interval, 0.848–1.044; P=0.249), and significant interaction existed with age. Results were unchanged in propensity score matched cohorts. Conclusion: The prognostic value of race-related biological differences of prostate cancer may hold less value in higher risk disease than is commonly believed.