Should the age specific prostate specific antigen cutoff for prostate biopsy be higher for black than for white men older than 50 years?

Purpose: Investigators who have examined age specific reference ranges reco mmend a higher prostate specific antigen (PSA) cutoff for biopsy for black than for white men older than 50 years. We controlled for PSA to determine whether age specific reference range cutoffs for diagnosis defined by the W aiter Reed Army Medical Center group (Walter Reed group) would improve the disproportionate prostate cancer prognosis between black and white men. Materials and Methods: We studied 651 consecutive patients who underwent ra dical prostatectomy at Wayne State University between 1991 and 1995 with a mean followup of 34 months (range 1.5 to 75). Log rank tests were used to d etermine the homogeneity of survival functions between black and white men with similar PSA ranges, and between groups defined by age specific PSA ref erence ranges for each race. Results: Disease stage and grade were similar or worse in black men for any PSA range, and biochemical disease-free survival was similar or worse with in each range. Black men had a higher percentage of high grade prostate can cer than white men 60 to 69 years old who would not have undergone biopsy u sing the Waiter Reed group proposed PSA cutoff. Conclusions: Black men have similar or worse prostate cancer severity and o utcome than white men with similar PSA ranges. Using age specific reference ranges for the PSA test defined by the Waiter Reed group, black men have w orse outcome than white men after radical prostatectomy. Therefore, we reco mmend that the PSA cutoff for biopsy should not be higher for black men at any age range.