Inflammatory infiltrate (prostatitis) in whole mounted radical prostatectomy specimens from black and white patients is not an etiology for racial difference in prostate specific antigen

Purpose: Although black men with and without prostatic carcinoma in general have higher levels of prostate specific antigen (PSA) than other racial gr oups, the cause is unknown. Previous studies have shown that black men prod uce greater PSA per cc of benign gland volume. We determined whether prosta tic inflammation varied by race and could account for the racial difference in PSA among prostate cancer patients. Materials and Methods: Between April 1993 and February 1997, 238 patients u nderwent radical prostatectomy for clinically localized prostate cancer at Waiter Reed Army Medical Center and whole mounted specimens were processed at the Armed Forces Institute of Pathology. Cases were reviewed by 2 pathol ogists (W.Z. and I.A.S.) blinded to clinical information, and scored for in flammation as 0-rare; 1-mild, 10 to 15 small foci; 2-moderate, greater than 15 foci with a large area or greater than 20 small foci; 3-marked, greater than 20 small foci with a large area, and 4-diffuse, multiple large areas. The extent of inflammation was correlated to pretreatment PSA and other va riables. Results: A total of 181 white and 57 black men were evaluated. Of the patie nts 28 were excluded from analysis due to prior hormonal therapy. The perce ntage of patients with inflammation scores from 1 to 4 was higher among whi te (113 of 161, 70.2%) than black (30 of 49, 61.2%) men but this difference was not significant (p = 0.299) and the extent of inflammation was not sig nificantly related to racial variation in serum PSA. Conclusions: To our knowledge no significant racial difference exists in th e extent of inflammatory infiltrate, and inflammation was not the etiology of the racial difference in serum PSA levels in this clinically localized p rostate cancer cohort.