The Relationship of Baseline Prostate Specific Antigen and Risk of Future Prostate Cancer and Its Variance by Race.

PURPOSE: Several studies suggest that a baseline prostate specific antigen (PSA) measured in young men predicts future risk of prostate cancer. Considering recent recommendations against PSA screening, high-risk populations (e.g. black men, men with a high baseline PSA) may be particularly vulnerable in the coming years. Thus, we investigated the relationship between baseline PSA and future prostate cancer in a black majority-minority urban population. MATERIALS AND METHODS: A retrospective analysis was performed of the prostate biopsy database (n = 994) at the Brooklyn Veterans Affairs Hospital. These men were referred to urology clinic for elevated PSA and biopsied between 2007 and 2014. Multivariate logistic regression was used to predict positive prostate biopsy from log-transformed baseline PSA, race (black, white, or other), and several other variables. RESULTS: The majority of men identified as black (50.2%). Median age at time of baseline PSA and biopsy was 58.6 and 64.8, respectively. Median baseline PSA was similar among black men and white men (2.70 vs 2.91 for black men vs white men, p = 0.232). Even so, black men were more likely than white men to be diagnosed with prostate cancer (OR 1.62, p < 0.0001). Black men less than age 70 were at particularly greater risk than their white counterparts. Baseline PSA was not a statistically significant predictor of future prostate cancer (p = 0.101). CONCLUSIONS: Black men were more likely to be diagnosed with prostate cancer than were white men, despite comparable baseline PSA. In our pre-screened population at the urology clinic, a retrospective examination of baseline PSA did not predict future prostate cancer.

The impact of African American race on prostate cancer detection on repeat prostate biopsy in a veteran population.

PURPOSE: Racial differences in the incidence of prostate cancer on initial biopsy are well established, but the predictive value of African American race on the probability of prostate cancer detection on repeat biopsy is unknown. MATERIALS AND METHODS: At a single institution between January 2007 and June 2014, we reviewed 277 men who first underwent a negative transrectal ultrasound guided needle biopsy of the prostate, and who then subsequently underwent a second biopsy. Detection rates were compared via Chi-square analysis. Race, age, PSA, presence of high-grade prostatic intraepithelial neoplasia, presence of atypical small acinar proliferation, prostate volume, PSA velocity and PSA density were compared via a multivariate logistic regression analysis. RESULTS: 496 AA men and 352 Caucasian men underwent initial biopsy, and AA men had a 49 % cancer detection rate, compared to 34 % in Caucasians (p < 0.0001). AA men also had a greater incidence of Gleason 7 cancers (p = 0.00018) and a smaller mean TRUS volume (p = 0.006) compared to Caucasians. On repeat biopsy, AA men no longer had a higher cancer detection rate (p = 0.227), nor difference in Gleason 7 detection or TRUS volume (p = 0.0992). On initial biopsy, AA race and increasing PSA were both associated with an increased likelihood for cancer detection (p < 0.001 for both). After an initial negative biopsy, AA race no longer predicted for future malignancy detection (p = 0.57), nor did PSA (p = 0.36). CONCLUSIONS: In a cohort of men with high pre-test probability of prostate cancer and an initial negative biopsy, African American race in a veteran population fails to predict the detection of future prostate cancer.