Secondary treatment was defined as any treatment received more than 1 year after primary therapy. Among the 60,885 patients who received primary radiation therapy, including 6,052 Black patients and 54,833 White patients, 17,058 patients, or 28.0%, received secondary treatment. Again, no significant racial differences were observed in the likelihood of receiving secondary treatment. Secondary analyses also suggested that the type of secondary treatment differed according to race, including the use of secondary radiation therapy, androgen deprivation therapy, and novel systemic therapies. Racial differences in secondary treatment pathways and survival in localized prostate cancer.