No racial disparities in prostate cancer-specific mortality after biochemical recurrence following radical prostatectomy or radiation therapy

Background: Racial disparities in prostate cancer are well-documented, with Black men experiencing twice the mortality of White men. While prior studies suggest these disparities reflect inequitable access rather than biology, only few studies have examined this in the biochemical recurrence setting, where screening and initial treatment biases are eliminated. We compared cancer-specific mortality and other-cause mortality between non-Hispanic Black (NHB) and non-Hispanic White (NHW) men with biochemical recurrence after initial treatment. Methods: This retrospective single health system study included patients who developed BCR after radical prostatectomy or radiation therapy between 1995 and 2023. Primary outcome was cancer-specific mortality. Fine-Gray competing risk models assessed race-CSM association, stratified by treatment and adjusted for European Association of Urology biochemical recurrence risk classification. Results: Among 968 patients (431 NHB, 44.5%; 537 NHW, 55.5%), median follow-up was 5.5 years from biochemical recurrence. Other-cause mortality was similar (Gray's test p = 0.35 radical prostatectomy, p = 0.41 radiation therapy). Ten-year cancer-specific mortality estimates were similar after radical prostatectomy (6.7% both races; NHB versus NHW HR 0.91, 95% CI 0.49-1.71, p = 0.8) and radiation therapy (NHB 26.7% versus NHW 32.4%; HR 0.71, 95% CI 0.44-1.14, p = 0.16). Limitations include single-center design and retrospective methodology. Conclusions: In this racially diverse single-center cohort, we found no racial disparities in cancer-specific mortality or other-cause mortality after biochemical recurrence. These findings support that racial disparities reflect modifiable access barriers rather than biological differences, emphasizing the importance of equitable care delivery.