Abstract B056: Comparative efficacy of definitive radiotherapy and radical prostatectomy in African American men with high-risk and very high-risk prostate cancer: A real-world institutional cohort study

Abstract

African American (AA) men experience the highest incidence and mortality from prostate cancer in the United States and are more likely to be diagnosed with aggressive disease. However, evidence comparing definitive treatment strategies for high-risk localized prostate cancer in AA men remains limited. We compared oncologic outcomes following radical prostatectomy (RP) versus definitive radiotherapy (RT ± androgen deprivation therapy [ADT]) among AA men with high-risk and very high-risk localized prostate cancer. AA men with high-risk or very-high-risk localized PCa as defined by NCCN risk stratification who underwent RP or RT at Mayo Clinic between 2010 and 2024 were identified. Outcomes of interest included biochemical recurrence (BCR) and distant metastases on imaging. BCR was defined as PSA ≥0.2 ng/mL after RP or nadir + 2 ng/mL after RT ± ADT. Patients with locoregional or synchronous metastatic disease were excluded. Baseline characteristics were compared using chi-square and t-test. Biochemical recurrence-free survival (BCRFS) and metastasis free survival (MFS) were estimated from date of treatment to event or censoring, using Kaplan Meier curves (log-rank test) stratified by NCCN risk group and treatment modality. Multivariable Cox regression, adjusting for age, risk group, PSA, Gleason score, special pathological features and treatment modality identified independent predictors of BCRFS and MFS. Among 112 patients with high-risk or very-high-risk localized prostate cancer, 63 received RT whereas 49 had RP as definitive treatment; median follow-up was 53.9 months (IQR 32.4–79.1), calculated as time from definitive treatment to last follow-up. Patients treated with RT were significantly older than those treated with RP (mean age, 68.3 vs. 62.3 years; p = 0.0002), with a higher proportion aged ≥65 years in the RT cohort (69.8% vs. 36.7%; p = 0.0010). PSA, clinical T-stage, Gleason score, and PSA nadir after definitive treatment were comparable between groups (all p > 0.05). Concurrent ADT with definitive treatment was more common with RT (90.5% vs. 6.1%, p < 0.0001). Median BCRFS was 48.3 months after RP vs. not reached after RT (p<0.0001); RT remained an independent predictor of reduced BCR risk on multivariable analysis (HR 0.10, 95% CI 0.02–0.52, p=0.006). Median MFS was 94.9 months after RP vs. not reached after RT (p=0.03), though this association did not persist after adjustment (HR 0.38, 95% CI 0.07–2.15, p=0.28). African American men experience the greatest burden of prostate cancer mortality, yet evidence guiding definitive treatment selection in this population remains limited. Our findings provide real-world comparative effectiveness data suggesting improved biochemical recurrence-free survival with definitive RT and help address an important evidence gap needed to support equitable treatment decision-making. Larger prospective studies are needed to guide treatment selection in this underrepresented population. Muhammad Umar Afzal, Ewan Kemar Cobran, Syed Arsalan Ahmed Naqvi, Umair Ayub, Sarah E. James, Usama Mumtaz Cheema, Yusra Saleem, Ibrahim Asiri, Irbaz Bin Riaz, Michael S. Staren, Noor Ul Ain Sarfraz Rana. Comparative efficacy of definitive radiotherapy and radical prostatectomy in African American men with high-risk and very high-risk prostate cancer: A real-world institutional cohort study [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B056.