The Impact of Race on Oncological Outcomes in Patients with an Initial Negative Prostate Biopsy: Results from a Contemporary U.S. Cohort.

[BACKGROUND] Exhaustive evidence about the impact of racial disparities in oncological outcomes after a negative prostate biopsy is still lacking. We explored the relationship between race and long-term oncological risk among men with an initial negative prostate biopsy using a contemporary U.S.

[METHODS] Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) men who had a negative prostate biopsy at Henry Ford Health between 1995-2023 were included. An Area Deprivation Index (ADI)-score was assigned to each patient based on their residential census-block group. The higher the ADI, the more the area has a socio-economic disadvantage. Competing-risk methods were used to estimate the cumulative incidence of any PCa diagnosis, clinically significant PCa diagnosis, receipt of active treatment, Prostate Cancer Specific Mortality (PCSM) and Other Cause Mortality (OCM) for the entire cohort of patients, after stratification according to race. Fine-Gray regression models tested the impact of race on the aforementioned outcomes.

[RESULTS] We included 17,446 men, 5,729 (30.3%) of whom were NHB. Within a median follow-up time of 7.8 years, the 15-years estimated rates of any PCa diagnosis, clinically significant PCa, active treatment and PCSM were 15.9% vs. 9.5%, 10.7% vs. 6.4%, 10.4% vs. 6.4% and 2.4% vs. 1.3%, for NHB versus NHW patients, respectively (all p-value < 0.0001). At multivariable analysis, NHB men had significantly higher hazard of any PCa (HR:1.90), clinically significant PCa (HR:1.91), active treatment for PCa (HR:1.84) and PCSM (HR:1.89) (all p < 0.001).

[CONCLUSIONS] NHB men, even after an initial negative prostate biopsy, face a higher risk of subsequent any PCa, clinically significant disease, active treatment and PCSM. Overall, these findings underscore the multifaceted impact of racial disparities on PCa prognosis.