 |
|
Prostate-Specific Antigen Values at the Time of Prostate Cancer Diagnosis in African-American Men
Judd W. Moul, MD;
Isabell A. Sesterhenn, MD;
Roger R. Connelly, MS;
Thomas Douglas, MD;
Shiv Srivastava, PhD;
Fathollah K. Mostofi, MD;
David G. McLeod, MD
JAMA. 1995;274(16):1277-1281.
Abstract
| |
Objective.
—To determine if African-American men with newly diagnosed prostate cancer (PC) have higher pretreatment serum prostate-specific antigen (PSA) values after adjustment for clinical stage, age, and tumor grade, and to determine if any difference detected is related to tumor volume difference.
Design.
—Consecutive case series of newly diagnosed PC patients between January 1990 and September 1994 and cohort analytic study of PC patients treated by radical prostatectomy (RP) and who had whole-mount pathologic tumor volume assessment between May 1993 December 1994.
Setting.
—Tertiary care military medical center.
Patients.
—A total of 541 evaluable newly diagnosed PC patients (408 white and 133 black) having pretreatment PSA assessment at one laboratory; 91 patients undergoing RP had whole-mount tumor volume analysis.
Interventions.
—Medical record review for pretreatment PSA value, race, tumor grade, clinical stage, and age, as well as whole-mount pathologic assessment of RP specimen and measurement of tumor volume.
Main Outcome Measures.
—The PSA differences between black and white PC patients with adjustments for age, biopsy tumor grade (Gleason score), and clinical stage (TNM stage); PSA differences between black and white PC patients undergoing RP with adjustment for age, RP grade, clinical stage, and tumor volume.
Results.
—The mean (geometric) PSA value for 133 black men was 14.00 ng/mL compared with 8.29 ng/mL for 408 white men (P<.001). The black patients had higher PSA values across all stage, grade, and age categories. The racial difference in PSA levels remained statistically significant when stage, grade, and age were simultaneously controlled for (P<.001). Multivariable odds ratio testing revealed that even after adjustment for stage, grade, and age, black patients were 2.2 times as likely as white patients to have a PSA value greater than 10.0 ng/mL (95% confidence interval, 1.3 to 3.6). Tumor volume (geometric mean) was 5.42 cm3 and 2.10 cm3 for black and white RP patients, respectively (P=.002). Across all clinical stages (T1 a to T3), black men had tumor volumes 1.3 to 2.5 times greater than those of white men. Multivariable analysis of covariance revealed that tumor volume and stage of disease were important predictors of PSA level, but race, grade, and age were not. (The percentage of white and black patients whose cancer was detected by screening [75.4% vs 70.4%] or who had symptoms [37.7% vs 29.6%] was not significantly different.)
Conclusions.
—As a group, African-American men with newly diagnosed PC have higher PSA values at initial diagnosis than white men. This PSA difference appears to be due to larger tumor volumes within clinical (TNM) stage categories among black patients. Elevated PSA value was a surrogate for larger tumor volume in this cohort of black men. This stage-for-stage tumor volume disparity even in an equal-access health care environment should prompt further study of screening behavior and/or biological differences of PC in the black population.
(JAMA. 1995;274:1277-1281)
Author Affiliations
From the Urology Service, Departments of Surgery and Clinical Investigation, Walter Reed Army Medical Center, Washington, DC (Drs Moul, Douglas, and McLeod); Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md (Drs Moul, Douglas, Srivastava, and McLeod and Mr Connelly); and Department of Genitourinary Pathology, Armed Forces Institute of Pathology, Washington, DC (Drs Sesterhenn and Mostofi).
Footnotes
The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the US Army or the Department of Defense.
Reprint requests to Department of Surgery, USUHS, 4301 Jones Bridge Rd, Bethesda, MD 20814-4799 (Dr Moul).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Relation of Serum Parathyroid Hormone and Serum Calcium to Serum Levels of Prostate-Specific Antigen: A Population-Based Study
Skinner and Schwartz
Cancer Epidemiol. Biomarkers Prev. 2009;18:2869-2873.
ABSTRACT
| FULL TEXT
Percentage of Tumor in Prostatectomy Specimens: A Study of American Veterans
Vollmer
Am J Clin Pathol 2009;131:86-91.
ABSTRACT
| FULL TEXT
National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers
Sturgeon et al.
Clin. Chem. 2008;54:e11-e79.
ABSTRACT
| FULL TEXT
Multilevel Analysis of the Impact of Community vs Patient Factors on Access to Immediate Breast Reconstruction Following Mastectomy in Maryland
Rosson et al.
Arch Surg 2008;143:1076-1081.
ABSTRACT
| FULL TEXT
Obesity-Related Plasma Hemodilution and PSA Concentration Among Men With Prostate Cancer
Banez et al.
JAMA 2007;298:2275-2280.
ABSTRACT
| FULL TEXT
Effects of False-Positive Prostate Cancer Screening Results on Subsequent Prostate Cancer Screening Behavior
Ford et al.
Cancer Epidemiol. Biomarkers Prev. 2005;14:190-194.
ABSTRACT
| FULL TEXT
Effect of Race on Biochemical Disease-free Outcome in Patients with Prostate Cancer Treated with Definitive Radiation Therapy in an Equal-Access Health Care System: Radiation Oncology Report of the Department of Defense Center for Prostate Disease Research
Johnstone et al.
Radiology 2002;225:420-426.
ABSTRACT
| FULL TEXT
Impact of Race on Prostate-Specific Antigen Outcome After Radical Prostatectomy for Clinically Localized Adenocarcinoma of the Prostate
Cross et al.
JCO 2002;20:2863-2868.
ABSTRACT
| FULL TEXT
Racial and Ethnic Differences in Advanced-Stage Prostate Cancer: the Prostate Cancer Outcomes Study
Hoffman et al.
JNCI J Natl Cancer Inst 2001;93:388-395.
ABSTRACT
| FULL TEXT
Molecular Forms of Prostate-specific Antigen and Human Kallikrein 2 as Promising Tools for Early Diagnosis of Prostate Cancer
Stephan et al.
Cancer Epidemiol. Biomarkers Prev. 2000;9:1133-1147.
ABSTRACT
| FULL TEXT
PSA Thresholds for Prostate Cancer Detection
Moul
JAMA 1997;278:699-699.
ABSTRACT
The CAG repeat within the androgen receptor gene and its relationship to prostate cancer
Giovannucci et al.
Proc. Natl. Acad. Sci. USA 1997;94:3320-3323.
ABSTRACT
| FULL TEXT
Predictive Properties of Serum Prostate-Specific Antigen Testing in a Community-Based Setting
Jacobsen et al.
Arch Intern Med 1996;156:2462-2468.
ABSTRACT
Age-Specific Reference Ranges for Serum Prostate-Specific Antigen in Black Men
Morgan et al.
NEJM 1996;335:304-310.
ABSTRACT
| FULL TEXT
|
