Prostate cancer biochemical recurrence stage for stage is more frequent among African-American than white men with locally advanced but not organ-confined disease

Objectives. To determine whether outcome differences between African-Americ an men (AAM) and white men with prostate cancer (PCa) will still be present if we control for stage in a large cohort of men. It is well established t hat AAM have a worse outcome from PCa than white men. Methods. We examined 848 consecutive patients who underwent radical prostat ectomy at Wayne State University, Karmanos Cancer Institute, between 1991 a nd 1995. The mean follow-up was 34 months (range 1.5 to 75). We included me n with Gleason score 7 (4 + 3) with those men with Gleason score 8 to 10 fo r racial/ethnic comparisons. Results. AAM and white men diagnosed with organ-confined PCa demonstrated s imilar prostate-specific antigen (PSA) levels, Gleason grade, and biochemic al recurrence. However, AAM diagnosed with non-organ-confined disease demon strated higher PSA levels and a higher incidence of recurrence than did whi te men with non-organ-confined disease. There was a trend toward AAM having a greater proportion of high-grade lesions than white men when PCa was not organ confined. The evidence suggests that the difference in recurrence am ong AAM versus white men is based on pretreatment PSA, grade, extracapsular extension, and positive surgical margins. Seminal vesicle invasion predict ed a worse prognosis equally for both AAM and white men. Conclusions. A difference in biochemical recurrence was not detected betwee n AAM and white men with organ-confined PCa after radical prostatectomy. PS A was higher in AAM than in white men with pathologically locally advanced PCa, and the biochemical recurrence was greater, AAM had a greater percenta ge of high Gleason grade lesions compared with white men, and this differen ce approached statistical significance. We hypothesize that AAM have a more rapid growth rate of PCa, which may be responsible for these clinical find ings. Further investigations of the biology of PCa are needed to understand these findings. (C) 2000, Elsevier Science Inc.