Changing face and different countenances of prostate cancer: Racial and geographic differences in prostate-specific antigen (PSA), stage, and grade trends in the PSA era

The purpose of this investigation was to examine changes in pretreatment pr ostate-specific antigen (PSA), stage, and grade over the past decade as a f unction of race and geographic region. A multiinstitutional database repres enting 6,790 patients (1,417 African-American, 5,373 white) diagnosed with nonmetastatic prostate cancer between 1988 and 1997 was constructed. PSA, s tage, and grade data were tabulated by calendar year and region, and time t rend analyses based on race and region were performed. There was an overall decline of PSA of 0.8%/year, which was significant (P = 0.0001), with a fa ster rate of decline in African-Americans (1.9%/year) than for whites (0.6% /year). The odds ratio (OR) for a stage shift was 1.09, which was significa nt (P < 0.0001), and this shift was greater in whites. The OR for an overal l grade shift was 1.15, which was significant (P < 0.0001). Although grade and PSA trends were similar for the different regions, there were significa nt regional differences in stage trends. The implications are that the face of prostate cancer has changed over the past decade; i.e., the distributio ns of stage, grade, and PSA (the most important prognosticators) have chang ed. In addition, the countenances of that face are different for whites and African-Americans. For African-Americans, this is good news: the stage, gr ade, and PSA distributions are more favorable now than before. For whites, the trends are more complex and more dependent on region. These findings sh ould be used for future clinical and health-policy decisions in the screeni ng and treatment of prostate cancer. (C) 2001 Wiley-Liss, Inc.