Racial differences and prostate cancer treatment decisions

Odds ratio for aggressive treatment choice by life expectancy across race and ethnicity. Credit: Prostate Cancer and Prostatic Diseases (2025). DOI: 10.1038/s41391-025-01036-w

Black men choose aggressive prostate cancer treatment—regardless of anticipated life expectancy—more often than Hispanic or Caucasian men, according to new research by Cedars-Sinai investigators published in the journal Prostate Cancer and Prostatic Diseases.

In the study, more than 2,000 men selected to mimic the sociodemographics of the U.S. prostate cancer population were asked to choose between conservative management and aggressive treatment in various prostate cancer diagnosis scenarios. These scenarios required participants to make treatment choices in the setting of different risks of cancer death and side effects, all while considering their anticipated life expectancy.

Life expectancy is important because prostate cancer is typically slow-growing, and treatment only benefits men with relatively long life expectancies. Among Hispanic and Caucasian men, lower life expectancy was associated with a lower likelihood of choosing aggressive treatment. Black men consistently elected to pursue aggressive treatment regardless of life expectancy. This pattern may put Black men at higher risk for overtreatment.

Timothy J. Daskivich, MD, director of Academic Urologic Oncology for the Department of Urology at Cedars-Sinai and corresponding author of the study, said more research is needed to determine why Black men routinely chose aggressive treatment.

“We have to be aware of cultural differences that may make different groups of patients pursue treatment for different reasons,” Daskivich said. “It’s important to have a holistic view and to understand patients’ motivations for making the decisions they do so that we can provide the best possible care.”

Older adult prostate cancer patients are increasingly being overtreated