Introduction: Prior studies have identified racial differences in urinary continence following radical prostatectomy (RP), but the mechanisms for these differences are unclear. Our objective was to evaluate the association between race and urinary continence following RP and to examine potential mechanisms for observed differences. Methods: Patient-reported urinary function outcomes were prospectively measured among men undergoing RP from 2014-2020 at Memorial Sloan Kettering Cancer Center (MSK; n = 3,895) and at Weill Cornell Medicine (WCM; n = 243). Urinary continence was defined as no or occasional pad use on the Prostate Quality of Life Survey at MSK and as no pads on the Expanded Prostate Cancer Index Composite for Clinical Practice at WCM. We fit multivariable generalized estimating equations for the outcome of urinary continence at 3, 6, 12, and 24 months, with race as our predictor of interest, adjusting for age, biopsy Gleason grade group, and tumor stage. We performed mediation analyses by examining the change in coefficient estimates for race after adding covariates to the base model: prostate volume, membranous urethral length, nerve sparing, BMI, diabetes, and surgeon volume. Results: We found evidence that men identifying as Black (OR 0.63; 95% CI: 0.48, 0.83; p=0.001) or Asian (OR 0.62; 95% CI: 0.42, 0.91; p=0.016) had lower rates of urinary continence over 24 months compared to white men. After adding covariates for mediation, we found no important changes in our estimated coefficients. Conclusions: Men identifying as Black or Asian had worse continence rates after RP, and these were not mediated by the comorbidities, anatomic or surgical factors we analyzed. Further research is needed to clarify the mechanisms underlying these observed differences. SOURCE OF Funding: This study was supported in part by the Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center (MSK), and a Cancer Center Support Grant (P30 CA008748) to MSK from the National Institutes of Health/National Cancer Institute.
