Prostate cancer detection in black and white men with abnormal digital rectal examination and prostate specific antigen less than 4 ng./ml.

Purpose: Prostate cancer is more common in black than in white American men . Experience in a longitudinal prostate cancer screening program implies th at cancer detection is greater in black than in white men with an abnormal digital rectal examination and prostate specific antigen (PSA) less than 4 ng./ml. We investigated potential racial differences in cancer detection in men treated in clinical practice who had an abnormal digital rectal examin ation and PSA less than 4 ng./ml. Materials and Methods: Between January 1992 and December 1999 prostate biop sy was done at a Veterans Affairs Medical Center in 179 black and 357 white men with an abnormal digital rectal examination, PSA less than 4 ng./ml. a nd no history of prostate surgery. Significant racial differences in demogr aphic and clinical parameters were limited to PSA, which was higher in blac k men (p = 0.01). Results: Cancer was detected in 38 black (21%) and 65 white (18%) men (p = 0.42). There were no significant racial differences in the PSA adjusted can cer detection rate or in the Gleason score of detected disease. In men with PSA less than 1.0, 1.0 to 1.9, 2.0 to 2.9 and 3.0 to 3.9 ng./ml. the detec tion rate was 4%, 15%, 27% and 29%, respectively. Conclusions: In clinical practice prostate cancer detection appears to be e quivalent in black and white men when an abnormal digital rectal examinatio n is the only indication of malignancy.