PROSTATE-SPECIFIC ANTIGEN AND PATHOLOGICAL FEATURES OF PROSTATE-CANCER IN BLACK-AND-WHITE PATIENTS - A COMPARATIVE-STUDY BASED ON RADICAL PROSTATECTOMY SPECIMENS
Ca. Pettaway et al., PROSTATE-SPECIFIC ANTIGEN AND PATHOLOGICAL FEATURES OF PROSTATE-CANCER IN BLACK-AND-WHITE PATIENTS - A COMPARATIVE-STUDY BASED ON RADICAL PROSTATECTOMY SPECIMENS, The Journal of urology, 160(2), 1998, pp. 437-442
Purpose: We compared the relationship of pathological features and pre
operative prostate specific antigen (PSA) levels of a consecutive seri
es of black patients to a stage matched cohort of white patients treat
ed during the same period. Materials and Methods: The radical prostate
ctomy specimens of 40 black patients were reviewed and tumor volume wa
s determined. Histopathological features (stage, grade, zonal distribu
tion of cancer foci), tumor volume and prostate weight were correlated
to pretreatment serum PSA levels. These parameters were compared with
those of 148 white patients matched by pathological stage. Results: B
lack patients exhibited a significantly higher incidence of seminal ve
sicle involvement (p = 0.03) and cancers with a Gleason score of 8 or
more (p = 0.02), and a trend toward decreased pathologically organ con
fined, margin negative disease (40% black versus 53% white men, p = 0.
13). Although the incidences of multifocal cancer were virtually ident
ical (90 and 82%) in the 2 groups, black patients exhibited a higher i
ncidence of transition zone cancer foci (p <0.001). Mean prostate tumo
r volume, total gland weight and serum PSA level among black and white
patients with pathological stage pT2-, pT2+ and pT3- cancer were not
significantly different. However, with advancing pathological stage (p
T3+ and pT3c) disease black patients had higher preoperative serum PSA
levels on univariate and multivariate analyses despite similar total
gland weight and tumor volume. Conclusions: Black patients who underwe
nt radical prostatectomy often exhibited adverse pathological features
. Two novel findings were that the distribution of cancer foci within
the prostate was significantly different between black and white patie
nts, and that serum PSA levels in patients with locally advanced prost
ate cancer were higher in black than in white men, despite adjustment
for known variables affecting PSA. These observations suggest that dif
ferences in the biology of prostate cancer between these 2 races may e
xist.