Prostate cancer risk is three-fold higher among men, aged 50-64, of African descent compared with men of Asian-Indian descent in Trinidad and Tobago.

OBJECTIVE: To test the hypothesis that the screening-detected prevalence of prostate cancer is higher among men of African descent than among men of Asian-Indian descent living in Trinidad & Tobago. DESIGN: Population-based prostate cancer screening study among men aged 50-64. SETTING: Caribbean islands of Trinidad and Tobago. PARTICIPANTS: Tobago, population-based sample of 1196 male residents of African descent; Trinidad, 173 agricultural workers of Asian-Indian descent. INTERVENTIONS: Serum prostate specific antigen (PSA, Abbot AxSYM) and digital rectal exam (DRE) were used to screen men for prostate cancer. Men with elevated PSA (> or = 4 ng/mL) and/or abnormal DRE were offered an ultrasound guided sextant biopsy of the prostate gland. MAIN OUTCOME MEASURES: Prevalence of abnormal screen; prevalence of prostate cancer. RESULTS: Elevated PSA and/or abnormal DRE were observed in 29% (348/1196) of Afro-Tobagonian men. Three hundred sixteen men underwent biopsies. Screening-detected prostate cancer prevalence was: 4.9% (23/468) for those aged 50-55; 7.7% (28/366) for those aged 55-59; and 13.3% (48/362) for those aged 60-64 years. Screening was abnormal in 18% (31/173) of Asian-Indian men; 25 underwent biopsies. Prostate cancer prevalence in Asian Indian men was: 1.6% (1/63) for those aged 50-54; 1.4% (1/71) for those aged 55-59; and 5.1% (2/39) for those aged 60-64 years. Mantel-Haenszel age-adjusted rate ratio was 3.4, 95% CI 1.3-9.0. CONCLUSIONS: This study establishes a high prevalence of screening-detected prostate cancer among Afro-Tobagonians compared with Indo-Trinidadians. Comparison of candidate genes, environmental, and lifestyle factors between these populations may identify factors that increase risk for, or provide protection against, prostate cancer.

Prostate cancer screening parameters in a high-risk African-Caribbean population.

OBJECTIVES: To estimate the prostate cancer screening parameters in a population-based study of African-Caribbean men from the Island of Tobago. METHODS: A total of 2582 men aged 40 to 79 years (50% of all Tobago men in this age group) were screened using both serum prostate-specific antigen (PSA) and digital rectal examination (DRE). Men with an elevated PSA level (4 ng/mL or greater) or abnormal DRE findings were referred for ultrasound-guided sextant biopsy. RESULTS: The screening results for one or both tests were abnormal in 32% of men. The prevalence of prostate cancer was 10.7 of 100 screened men. The positive predictive value for PSA was 56% compared with 39% for DRE. The positive predictive value for PSA ranged from 6% for those aged 40 to 49 years to 59% for those aged 70 to 79 years. The sensitivity was 71% and the specificity 86% for DRE. The sensitivity for PSA was 80%. The sensitivity was low among men aged 40 to 49 years (20%) and 50 to 59 years (66%). The specificity for PSA declined across age groups from 98% for those aged 40 to 49 years to 70% for those 70 to 79 years. CONCLUSIONS: The screening parameters in this African-Caribbean population were similar to the sparse data available from other populations of African descent. The screening was highly efficacious, with a positive predictive value of 56% for an elevated PSA level and 40% for an elevated PSA level and/or abnormal DRE findings.