title: Racial differences in serum prostate-specific antigen (PSA) doubling time, histopathological variables and long-term PSA recurrence between African-American and white American men undergoing radical prostatectomy for clinically localized prostate cancer.
abstract: OBJECTIVE
  To determine if there are significant differences in biochemical characteristics, biopsy variables, histopathological data, and rates of prostate-specific antigen (PSA) recurrence between African-American (AA) and white American (WA) men undergoing radical prostatectomy (RP), as AA men are twice as likely to die from prostate cancer than their white counterparts.
  
  
  METHODS
  We established a cohort of 1058 patients (402 AA, 646 WA) who had RP and were followed for PSA recurrence. Age, race, serum PSA, biopsy Gleason score, clinical stage, pathological stage, and PSA recurrence data were available for the cohort. The chi-square test of proportions and t-tests were used to assess basic associations with race, and log-rank tests and Cox regression models for time to PSA recurrence. Forward stepwise variable selection was used to assess the effect on the risk of PSA recurrence for race, adjusted by the other variables added one at a time.
  
  
  RESULTS
  The AA men had higher baseline PSA levels, more high-grade prostatic intraepithelial neoplasia (HGPIN) in the biopsy, and more HGPIN in the pathology specimen than WA men. The AA men also had a shorter mean (sd) PSA doubling time before RP, at 4.2 (4.7) vs 5.2 (5.9) years. However, race was not an independent predictor of PSA recurrence (P = 0.225). Important predictors for PSA recurrence in a multivariable model were biopsy HGPIN (P < 0.014), unilateral vs bilateral cancer (P < 0.006), pathology Gleason score and positive margin status (both P < 0.001).
  
  
  CONCLUSIONS
  This study indicates that while there are racial differences in baseline serum PSA and incidence of HGPIN, race is not an independent risk factor for PSA recurrence. Rather, other variables such as pathology Gleason score, bilateral cancers, HGPIN and margin positivity are independently associated with PSA recurrence. The PSA doubling time after recurrence may also be important, leading to the increased mortality of AA men with prostate cancer.
authors.affiliation: Josephine Ford Cancer Center and Vattikuti Urology Institute, Henry Ford Health, System, Detroit, MI, USA.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tewari
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.forename: Mazen
authors.initials: M
authors.lastname: Hasan
authors.forename: Steven
authors.initials: S
authors.lastname: Coon
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Gamito
authors.forename: John
authors.initials: J
authors.lastname: Wei
authors.forename: David
authors.initials: D
authors.lastname: Taub
authors.forename: James
authors.initials: J
authors.lastname: Montie
authors.forename: Chris
authors.initials: C
authors.lastname: Porter
authors.forename: George W
authors.initials: GW
authors.lastname: Divine
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000208:ethnology / Q000473:pathology; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000208:ethnology* / Q000473:pathology; D012189:Retrospective Studies; D044465:White People
chemical_list: D017430:Prostate-Specific Antigen