Racial Differences in Psychosocial Outcomes Among Prostate Cancer Survivors: Insights From the All of Us Research Program.

Introduction Prostate cancer (PCa) survivorship is associated with substantial psychological distress, yet racial differences in mental health outcomes are incompletely understood. We used multivariable logistic regression models to evaluate associations between race and post-diagnosis depressive episodes and patient-reported psychosocial outcomes, including quality of life, mental health, and social satisfaction, among PCa survivors in a diverse national cohort. Methods We conducted a cross-sectional study using the National Institutes of Health (NIH) All of Us Research Program Controlled Tier Dataset (version 8). Adults with electronic health records (EHR)-documented PCa who completed surveys after diagnosis were included. Non-Hispanic White (NHW) and Black participants were compared. Primary outcomes included depressive episodes after diagnosis and patient-reported quality of life, mental health, and social satisfaction. Multivariable regression models adjusted for age, time since diagnosis, socioeconomic factors, medical comorbidities, and baseline depression. Results Among 4,524 PCa survivors, 3,965 (87.6%) were NHW and 559 (12.4%) were Black. Black participants were younger (median 66.8 years vs 72.6, p<0.001) and experienced greater socioeconomic disadvantage (219 (39.2%) with <$25,000 annual household income vs. 262 (6.6%), p<0.001). Depressive episodes were more common among Black individuals (97 (17.4%) vs 509 (12.8%)). On univariate analysis, Black race was associated with higher odds of depressive episode (OR 1.31, 95% CI 1.07-1.59, p=0.008), but this association did not persist after adjustment (adjusted OR 0.80, 95% CI 0.60-1.06, p=0.119). In contrast, NHW participants reported worse psychosocial outcomes, with higher proportions reporting fair or poor quality of life, mental health, and social satisfaction. Black race was associated with lower odds of worse self-reported primary outcomes on univariate analysis; after adjustment, this association persisted for quality of life (adjusted OR 0.75, 95% CI 0.61-0.92, p=0.005). Conclusion Racial differences in EHR-documented depression were largely explained by socioeconomic factors, while patient-reported psychosocial outcomes were similar or more favorable among Black individuals. Divergence between clinical diagnoses and patient-reported measures highlights challenges in accurately assessing psychological distress across populations.