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The adjusted subdistribution hazard ratio of SPBC was 1.80 (95 % CI 1.30-2.48) for radiation recipients compared to surgery recipients among white patients; 1.93 (95 % CI 1.36-2.74) if restricted to external beam radiation therapy (EBRT). The SPBC risk was not significantly different between irradiated and surgically treated among blacks. The SPBC risk is almost two-fold among white irradiated PCa patients compared to their counterparts treated surgically. Our findings highlight the need for enhanced surveillance for white PCa survivors