COMPARISON OF SERUM PROSTATE-SPECIFIC ANTIGEN LEVELS AND PSA DENSITY IN AFRICAN-AMERICAN, WHITE, AND HISPANIC MEN WITHOUT PROSTATE-CANCER

Objectives. To determine the influence of race or ethnicity on serum p rostate-specific antigen (PSA) levels and PSA density (PSAD) in a popu lation of healthy men without clinically evident prostate cancer. Meth ods. This retrospective study was conducted between January 1988 and J anuary 1993. The serum PSA levels were measured in 859 men (586 Africa n Americans, 142 whites, and 131 Hispanics) who were participants in a prostate cancer screening program or had urinary symptoms suggestive of prostate gland pathology. All men underwent a detailed clinical exa mination, including digital rectal examination, serum PSA determinatio n, and transrectal ultrasound (TRUS). None of the subjects included ha d clinical or TRUS evidence of prostate cancer (furthermore, 283 men w ere pathologically proved to be cancer-free by prostate biopsies). Ser um PSA levels and PSA densities as a function of each individual's eth nic background were determined. Results. The mean serum PSA level in A frican Americans was 2.1 ng/mL, which was significantly higher than th at of whites (mean PSA of 1.53 ng/mL) and Hispanics (mean PSA of 1.83 ng/mL) (P = 0.003). Similar differences among the three groups were ob served in PSA density (the mean PSAD was 0.078, 0.057, and 0.065 for A frican Americans, whites, and Hispanics, respectively). A separate ana lysis for the biopsy-negative men was performed, and the findings were consistent with the observations for the entire study group. After ad justment for age and prostate volume, the differences remained statist ically significant. Conclusions. Among men without evidence of prostat e cancer, African Americans have higher serum PSA levels and PSA densi ties than do whites or Hispanics. Race or ethnicity was an independent factor that affected serum PSA levels even after adjustment for age a nd prostate volume. (C) 1998, Elsevier Science Inc. All rights reserve d.