CLINICAL CHARACTERISTICS AND BIOPSY SPECIMEN FEATURES IN AFRICAN-AMERICAN AND WHITE MEN WITHOUT PROSTATE-CANCER

Background: The reported incidence of prostate cancer is higher among African-American men than among white men, We conducted a study of Afr ican-American and white men without prostate cancer to determine wheth er clinical and histologic findings might be associated with racial di fferences in serum prostate-specific antigen (PSA) levels, Methods: Fr om January 1990 through March 1997, 493 (59.5%) of 829 African-America n men and 736 (74.1%) of 993 white men who had elevated serum PSA leve ls (greater than or equal to 4.0 ng/mL) and/or abnormal digital rectal examinations and who underwent transrectal ultrasound-guided prostate biopsies were found to be without prostate cancer. Also reviewed were patients' age and race, indication for biopsy, histologic features of the prostate biopsy specimen, ultrasound-measured prostate volume, PS A density (i.e., the PSA level divided by the prostate volume), and (i n some cases) serum testosterone levels. Results: Among these men with out prostate cancer, there were no statistically significant differenc es by race in the ages of the patients, their prostate volumes, or the ir serum testosterone levels; however, the mean serum PSA levels and P SA densities were significantly higher in African-American men than in white men (two-sided P values of .00003 and .000009, respectively). A higher proportion of African-American men than white men had inflamma tion in their prostate biopsy specimen, and men of both races with pro state inflammation had higher PSA values than those without inflammati on. African-American men without inflammation had higher PSA values th an white men without inflammation. Conclusions: In this study, African -American men without histologic evidence of prostate cancer had signi ficantly higher PSA levels and PSA densities than similarly aged white men. This finding was not accounted for by racial differences in pati ents' age, serum testosterone level, or prostate volume.