Should African-American men be tested for prostate carcinoma at an earlierage than white men?

BACKGROUND. There have recently been challenges to testing high risk popula tions, i.e., African-American men younger than 50 years, for prostate carci noma (PCa). The mortality rate of patients with PCa between ages 40 and 60 years is nearly 3 times greater among African-American men (AAM) compared w ith white men (WM). The literature in support of testing AAM at an earlier age than WM is sparse. Therefore, the authors present clinical and histolog ic data that support the testing of AAM at a younger age, utilizing data on patients with clinically localized PCa. METHODS. Examination of consecutive radical prostatectomy specimens from AA M and WM was performed from January 1991 to June 1996 among AAM and WM at W ayne State University, Harper Hospital, Detroit, Michigan. International, s alvage prostatectomy, and neoadjuvant hormonal therapy patients were exclud ed, as were patients with lymph node metastasis. The authors examined bioch emical recurrences of PCa in this cohort of men treated from January 1991 t hrough December 1995. Univariate analysis of contingency tables was perform ed, using chi-squared-tests to assess the correlation between stage and rac e after stratification of patients by age group. Biochemical recurrence was analyzed using the Kaplan-Meier method and the log rank test RESULTS. The authors examined radical prostatectomy specimens from 759 pati ents and biochemical recurrence outcome of 655 patients. AAM patients ages 50-69 years had higher prostate specific antigen levels, worse Gleason scor es, more advanced stages of disease, and a higher recurrence rate. However, among men ages 70-79 years, there was no difference in these parameters be tween AAM and WM. Among men ages 40-49 years, a larger sample size is neces sary to make meaningful comparisons. CONCLUSIONS. Data on the outcomes of men treated for clinically localized P Ca demonstrated more advanced disease and more frequent recurrence among yo ung AAM than among WM, young and of advanced age. These differences in dise ase severity and recurrence, in addition to the disproportionate mortality among young AAM, are strong evidence that AAM should be tested for PCa at a n earlier age than WM. (C) 1999 American Cancer Society.