PRETREATMENT PROSTATE-SPECIFIC ANTIGEN VALUES IN PATIENTS, WITH PROSTATE-CANCER - 1989 PATTERNS OF CARE STUDY PROCESS SURVEY

Purpose: A Patterns of Care Study (PCS) national survey was conducted to show the national averages for processes of radiation therapy care for prostate cancer patients in 1989, In the current study we report a n analysis of pretreatment prostate-specific antigen (PSA) by stage, g rade, and ethnic origin. Methods and Materials: Process data were coll ected from 672 patients treated in 1989 at 71 separate institutions, F our hundred and twenty-seven (64%) of these patients had a pretreatmen t PSA value recorded, Three hundred and forty-three of the 427 patient s were treated with external beam irradiation alone and were selected for the current analysis, The 1992 AJCC staging system was used. Resul ts: There was a significant increase in pretreatment PSA with increasi ng stage, The median values of PSA were 8.3 ngm/ml in the T1 group (n = 65), 11.2 ngm/ml in the T2 group (n = 178), and 20.9 ngm/ml in the T 3 group (n = 90) (p < 0.001), Ten patients were not staged, There was a significant increase in pretreatment PSA with decreasing differentia tion. The median pretreatment PSA was 9.7 ngm/ml in well-differentiate d tumors (n = 109), 13.0 ngm/ml in moderately differentiated tumors (n = 163), and 22.0 ngm/ml in poorly differentiated tumors, (n = 61) (p < 0.001), Ten patients had no differentiation recorded, African Americ ans (24) showed a significant increase in pretreatment PSA compared to Caucasians (304), The respective medians were 23.2 ng/ml and 11.9 ng/ ml (p = 0.04). They also show more poorly differentiated tumors (33% v s, 17%) and more T3 tumors (46% vs, 25%), Other minorities, although s mall in number (n = 9) were similar to African Americans. Conclusion: Pretreatment PSA levels were established for patients treated with ext ernal beam irradiation in 1989 in the United States, They increase wit h stage and decreasing differentiation, African Americans and other mi norities show a doubling of median values compared to Caucasians' pret reatment PSA with an increase in stage and grade. The adverse prognosi s observed for African Americans is predicted by their pretreatment PS A, The cause of this PSA elevation is not known and may be related to lack of access to care or to a more aggressive biology for prostate ca ncer in African Americans.