THE PREDICTIVE VALUE OF RACE AS A CLINICAL PROGNOSTIC FACTOR AMONG PATIENTS WITH CLINICALLY LOCALIZED PROSTATE-CANCER - A MULTIVARIATE-ANALYSIS OF POSITIVE SURGICAL MARGINS

Objectives. Several investigators have reported that African-American men with clinically localized prostate cancer have poorer survival tha n do white men. In addition, prostate cancer in African-American men i s commonly diagnosed at a more advanced stage of disease. Is race or e thnicity predictive of outcome of clinically localized prostate cancer ? It has been reported that the presence of positive surgical margins significantly influences time to progression independently of other pr ognostic factors. Therefore, we have elected to conduct a multivariate analysis of clinical factors including race as potential predictors o f positive surgical margin outcome. Methods. We studied 369 consecutiv e men (120 African-American and 249 white) who had radical prostatecto mies at a single institution. Comparisons by race of Gleason score, st age, presence of positive surgical margins, and mean preoperative pros tate-specific antigen (PSA) level were carried out. Results. Our data demonstrate that African-American men have more pathologically locally advanced prostate cancer than do white American men: 69% among blacks compared with 57% among whites. However, the difference in rate of po sitive surgical margins between blacks and whites is statistically sig nificant: 58% among blacks versus 40% among whites (P = 0.002). Four f actors were predictive of positive surgical margins: preoperative PSA level, race, clinical stage, and Gleason score. Conclusions. We have d emonstrated that race is an independent predictor of positive surgical margins among patients with clinically localized prostate cancer and should be included in treatment decisions. In addition, the risk of po sitive surgical margins increases noticeably when PSA is greater than 10 ng/mL. (C) 1997, Elsevier Science Inc.