title: Should the age specific prostate specific antigen cutoff for prostate biopsy be higher for black than for white men older than 50 years?
abstract: OBJECTIVE
  Investigators who have examined age specific reference ranges recommend a higher prostate specific antigen (PSA) cutoff for biopsy for black than for white men older than 50 years. We controlled for PSA to determine whether age specific reference range cutoffs for diagnosis defined by the Walter Reed Army Medical Center group (Walter Reed group) would improve the disproportionate prostate cancer prognosis between black and white men.
  
  
  METHODS
  We studied 651 consecutive patients who underwent radical prostatectomy at Wayne State University between 1991 and 1995 with a mean followup of 34 months (range 1.5 to 75). Log rank tests were used to determine the homogeneity of survival functions between black and white men with similar PSA ranges, and between groups defined by age specific PSA reference ranges for each race.
  
  
  RESULTS
  Disease stage and grade were similar or worse in black men for any PSA range, and biochemical disease-free survival was similar or worse within each range. Black men had a higher percentage of high grade prostate cancer than white men 60 to 69 years old who would not have undergone biopsy using the Walter Reed group proposed PSA cutoff.
  
  
  CONCLUSIONS
  Black men have similar or worse prostate cancer severity and outcome than white men with similar PSA ranges. Using age specific reference ranges for the PSA test defined by the Walter Reed group, black men have worse outcome than white men after radical prostatectomy. Therefore, we recommend that the PSA cutoff for biopsy should not be higher for black men at any age range.
authors.affiliation: Department of Pathology, Harper Hospital, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan, USA.
authors.forename: I J
authors.initials: IJ
authors.lastname: Powell
authors.forename: M
authors.initials: M
authors.lastname: Banerjee
authors.forename: M
authors.initials: M
authors.lastname: Novallo
authors.forename: W
authors.initials: W
authors.lastname: Sakr
authors.forename: D
authors.initials: D
authors.lastname: Grignon
authors.forename: D P
authors.initials: DP
authors.lastname: Wood
authors.forename: J E
authors.initials: JE
authors.lastname: Pontes
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D012016:Reference Values; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D017430:Prostate-Specific Antigen