A prospective study of the serum prostate specific antigen concentrations and gleason histologic scores of black and white men with prostate carcinoma

BACKGROUND. The stage specific survival rates of black American men with pr ostate carcinoma are less favorable than those of white American men. The a uthors conducted a prospective study of the serum prostate specific antigen (PSA) concentrations and Gleason histologic scores of black and white men with newly diagnosed prostate carcinoma to determine whether there were rac ial differences in these prognostic variables. METHODS. At a Veterans Affairs Medical Center between January 1, 1992, and December 31, 1997, clinical stage, Gleason histologic score, serum PSA conc entration, prostate volume, and PSA density were determined for 796 consecu tive men (465 black and 331 white) who had biopsy-detected prostate carcino ma. RESULTS. The percentages, respectively, of black and white men with local, regional, and metastatic carcinoma were 58 and 72; 22 and 17; and 20 and 11 (P < 0.0001). Of 271 black and 329 white men with local stage cancer, 20% and 12%, respectively, had Gleason 8-10 tumors (P = 0.02), and the age-adju sted risk of Gleason 8-10 cancer was 1.39 times greater for black men (95% confidence interval [CI] = 1.09-2.93). Gleason 8-10 cancer was found in 12 of 68 black (18%) and 5 of 87 white (6%) men with local cancer who were age 65 years or younger (P = 0.02). Among black and white men with local stage cancer, the mean PSA was 12.9 (95% CI = 11.5-14.4) and 8.5 (95% CI = 7.6-9 .4) ng/mL, respectively (P < 0.0001), and among black and white men with re gional stage cancer the mean PSA was 53.5 (95% CI = 42.7-63.9) and 35.0 (95 % CI = 27.3-42.6) ng/mL, respectively (P = 0.02). The mean PSA of black and white men with local cancer who were age 65 years or younger was 11.6 (95% CI = 8.8-14.4) and 6.9 (95% CI = 5.9-8.0) ng/mL, respectively (P = 0.0009) , CONCLUSIONS. Disparities in the risk of Gleason score 8-10 cancer for black and white men with local stage disease and in the serum PSA concentrations of black and white men with local and regional stage disease help to expla in racial differences in cancer survival. Racial differences in the risk of Gleason 8-10 cancer and in the serum PSA concentrations of men age 65 year s or younger have implications regarding the potential benefits of screenin g for prostate carcinoma in the African American community. (C) 1999 Americ an Cancer Society.