Prostate cancer screening and detection in inner-city and underserved men.
BACKGROUND
In the era of serum prostate-specific antigen (PSA) screening, the incidence of prostate cancer has increased dramatically. Simultaneously however, stage migration has occurred, and treatment outcomes have improved. Inner-city men have lower screening rates and, thus, may be diagnosed with more advanced disease that it less likely to be successfully treated.


OBJECTIVE
To assess the detection rate of prostate cancer and tumor stage at presentation in inner-city men.


METHODS
A retrospective cohort of 368 men underwent transrectal ultrasound needle-guided biopsy at an inner-city hospital from January 2003 to May 2005. Clinical and pathologic data were collected and analyzed.


METHODS
Clinic and hospital records were reviewed for several key outcomes, including prostate cancer incidence, tumor stage and tumor grade.


RESULTS
The median age of the cohort was 67 +/- 9.1 years (range, 23-93 years). Prostate cancer was diagnosed in 44% of subjects (161/368). The median PSA level at the time of diagnosis was significantly higher in African-American men than in Caucasian men (9.82 vs. 5.97 ng/mL, P=0.008). Abnormally high serum PSA levels (>20 ng/mL) were present in disproportionately more African-American men than Caucasian men with prostate cancer (32.9% vs. 19.7% P=0.011). African-American men in this inner-city cohort also had a higher incidence of advanced disease or distant metastasis (T3/T4, N1, or M1) than did Caucasians (16.1% vs. 3.8%; P=0.045).


CONCLUSIONS
Compared with inner-city Caucasian men, disproportionately more inner-city, African-American men present with advanced prostate cancer. This observation warrants prostate cancer education and consideration of early detection programs in underserved inner-city communities.
Anai
Satoshi
S
Division of Urology, University of Florida, Jacksonville 32209, USA.
Pendleton
John
J
Wludyka
Peter
P
Williams
Christopher
C
Nelms
Leah
L
Pettaway
Curtis
C
Rosser
Charles J
CJ
D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D051517:Digital Rectal Examination; D005431:Florida; D006801:Humans; D008297:Male; D008403:Mass Screening; D008507:Medically Underserved Area; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D014505:Urban Population; D044465:White People
D017430:Prostate-Specific Antigen