Hoeh B, Würnschimmel C, Flammia RS, et al. - Radical prostatectomy (RP) could afford a cancer-specific mortality (CSM) benefit over external beam radiotherapy (EBRT) in Johns Hopkins University (JHU) very high-risk African American patients but not in JHU high-risk African American patients.

• This study involved 4,165 National Comprehensive Cancer Network (NCCN) high-risk patients, of whom 1,944 (46.7%) and 2,221 (53.3%) qualified for JHU high-risk or very high-risk definitions.

• A total of 1,390 (33.5%) patients underwent RP vs 2,775 (66.6%) treated with EBRT.

• The 5-year CSM rates in the NCCN high-risk cohort were noted to be 2.4 vs 5.2% for RP vs EBRT, with a multivariable hazard ratio of 0.50 favoring RP.

• 5-year CSM rates in JHU very high-risk patients were 3.7 vs 8.4% for RP vs EBRT, respectively, with a multivariable hazard ratio of 0.51 favoring RP.

• Conversely, there was no significant CSM difference between RP vs EBRT in JHU high-risk patients (5-year CSM rates: 1.3 vs 1.3%; multivariable hazard ratio: 0.55).