Racial and Socioeconomic Disparities in Survival Among Patients with Metastatic Prostate Cancer: A SEER Population-Based Study

Background: Prostate cancer remains a major cause of cancer morbidity and mortality among men in the United States. Differences in diagnosis and survival across racial and socioeconomic groups continue to raise concern in clinical and public health research. Population based datasets provide an opportunity to examine patterns of advanced disease and survival outcomes across diverse demographic groups. Objective: This study evaluated racial and socioeconomic disparities in cancer-specific survival among patients with metastatic prostate cancer using a national population-based dataset. Methods: A retrospective population-based study was conducted using data from the Surveillance, Epidemiology, and End Results program. Patients diagnosed with malignant prostate cancer between 2004 and 2020 with distant stage disease were included. The final analytic sample consisted of 54,062 patients. Variables included race and ethnicity, age group, metastatic sites at diagnosis, treatment variables, and median household income. Descriptive analyses compared characteristics by cancer specific death using chi square tests for categorical variables and t tests for continuous variables. Survival patterns were examined using Kaplan Meier methods and log rank tests. Multivariable Cox proportional hazards model was used to estimate adjusted hazard ratios for factors associated with cancer specific mortality. Results: Cancer specific mortality differed across racial and socioeconomic groups. Higher mortality was observed among non-Hispanic Black patients(aHR=1.15,95% CI: 1.00 to 1.31, p =0.046) and non-Hispanic American Indian or Alaska Native patients(aHR=1.15, 95% CI :1.10 to 1.20, p < 0.001) compared with non-Hispanic White patients, while Hispanic and non-Hispanic Asian or Pacific Islander patients showed lower mortality risk. Older age groups demonstrated higher mortality. Liver, lung, and brain metastases were associated with increased risk of prostate cancer death. Patients in higher income groups showed lower mortality compared with patients in lower income groups (aHR=0.83, 95% CI : 0.80 to 0.87, p < 0.001). Conclusion: This study highlights persistent racial and socioeconomic differences in cancer specific survival among patients with advanced prostate cancer in the United States. These findings support continued efforts to address disparities in early detection, access to care, and treatment pathways. Future research should further explore clinical and structural factors that influence survival differences across population groups.