Prospective study of correlations between biopsy-detected high grade prostatic intraepithelial neoplasia, serum prostate specific antigen concentration, and race

BACKGROUND. High grade prostatic intraepithelial neoplasia (HGPIN), a prema lignant lesion of the prostate gland, is more common in black men than in w hite men. The influence of HGPIN on the serum prostate specific antigen (PS A) concentration is controversial, and correlations between HGPIN and PSA i n black men and white men have not been investigated. METHODS. Between January 1992 and December 1998, 411 black men and 639 whit e men with suspected prostate carcinoma underwent an initial benign prostat e biopsy at a single medical center. The presence or absence of HGPIN in th e biopsy specimens was determined by one uropathologist. RESULTS. HGPIN was identified in 8.9% of the specimens. When stratified by PSA concentration (<4.0 ng/mL, 4.0-9.9 ng/mL, and <greater than or equal to >10.0 ng/mL), HGPIN was associated with an increased PSA concentration only among men with PSA concentrations < 4.0 ng/mL (P = 0.01). The prevalence o f HGPIN in the black and white patients was 13.4% and 5.9%, respectively (P < 0.0001), and was significantly greater in black men than in white men wi th PSA concentrations < 4.0 ng/mL (P = 0.002). Among the patients with PSA concentrations < 4.0 ng/mL, black race was an independent predictor of an i ncreased PSA concentration when adjusted for patient age, prostate volume, and the presence or absence of HGPIN (P = 0.03). CONCLUSIONS, HGPIN is more common in black men than in white men and may pr oduce an increase in the PSA concentration. However, racial differences in the prevalence of HGPIN may not contribute to racial differences in PSA con centrations among men with no clinical or histologic evidence of carcinoma. (C) 2001 American Cancer Society.