Black men with prostate cancer had a persistently higher hazard of cancer-specific mortality compared to White men (HR 1.07; 95% CI 1.03-1.11) that did not attenuate over time.
Do racial disparities in prostate cancer-specific mortality persist over time conditional on survival?
Racial disparities in prostate cancer survival, particularly the higher mortality hazard for Black men compared to White men, are established at diagnosis and persist for at least 5 years.
Abstract Background: Racial disparities in prostate cancer survival are well-documented, but it is less clear how these mortality risks evolve as patients survive longer. Conditional survival (CS) provides a more dynamic and accurate prognosis for survivors by updating survival estimates over time. Objective: To investigate racial differences in cancer-specific survival (CSS) and 5-year conditional survival (CS) among men with prostate cancer. We also assessed how the multivariable-adjusted hazard of cancer-specific mortality (CSM) by race changes conditional on time already survived. Methods: We conducted a retrospective cohort study of 235,972 men diagnosed with prostate cancer (2004-2015) from the SEER database, limited to patients with known PSA and Gleason scores. We used Kaplan-Meier methods to estimate 5-year CSS at diagnosis and 5-year CS for men who had already survived 1-5 years. A series of time-varying multivariable Cox proportional hazards models were fit to calculate Hazard Ratios (HRs) for CSM, adjusting for age, sociodemographics, tumor characteristics (stage, grade, PSA, Gleason), and treatment. Results: At diagnosis (0 years survived), 5-year CSS was 95.9% for White men, 96.2% for Asian/Pacific Islander (API) men, 94.6% for Black men, and 92.8% for American Indian/Alaska Native (AI/AN) men. While 5-year CS improved for all groups who survived 5 years, the gap between Black (95.5%) and White (96.1%) men narrowed but persisted. In multivariable Cox models at diagnosis, Black men had a significantly higher hazard of CSM compared to White men (HR: 1.07; 95% CI: 1.03-1.11, P 0.001). This elevated mortality risk did not attenuate over time. Conversely, API men had a persistent survival advantage (HR at Year 0: 0.72; 95% CI: 0.68-0.77, P 0.001). The mortality hazard for AI/AN men was not statistically different from White men (HR at Year 0: 1.06; 95% CI: 0.87-1.29, P=0.54). Conclusion: Racial disparities in prostate cancer survival are established at diagnosis and, for Black and API men, persist for at least 5 years, even after adjusting for a comprehensive set of clinical and sociodemographic factors. The persistently higher mortality hazard for Black men highlights that survival gaps are not limited to factors at diagnosis. The lack of a significant difference for AI/AN men, despite lower initial CSS, warrants further investigation. These findings are critical for providing a more accurate, dynamic prognosis in long-term patient counseling. Citation Format: Brendon Wang, Andrew Chen, Irene Wang, Candice Johnstone. The persistence of racial disparities in prostate cancer survival: A time-varying conditional survival and mortality analysis abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3577.
Wang et al. (2026) studied this question. Black men with prostate cancer had a persistently higher hazard of cancer-specific mortality compared to White men (HR 1.07; 95% CI 1.03-1.11) that did not attenuate over time.