title: Black race does not independently predict adverse outcome following radical retropubic prostatectomy at a tertiary referral center.
abstract: OBJECTIVE
  There is controversy in the literature as to whether black race is associated with poorer oncological outcomes among men undergoing radical prostatectomy for clinically localized prostate cancer. To address this issue we examined the outcomes of a cohort of black and white men treated by multiple surgeons at our institution.
  
  
  METHODS
  The study population consisted of 4,962 white and 326 black men treated with anatomical radical retropubic prostatectomy between 1988 and 2004 by 10 different surgeons at the Johns Hopkins Hospital, a tertiary care referral center. We evaluated the association between race and adverse pathological features, and biochemical progression.
  
  
  RESULTS
  Black men had significantly higher preoperative serum prostate specific antigen (mean 7.2 vs 6.0 ng/ml, p <0.001), body mass index (median 27.4 vs 26.3 kg/m, p <0.001) and incidence of higher grade disease (Gleason sum 4 + 3 or greater) on prostate biopsy (17% vs 14%, p = 0.011). After adjustment for multiple clinical variables there was no statistically significant association between race and the adverse pathological characteristics of high grade disease, positive surgical margins, extraprostatic extension or seminal vesicle invasion. Black race was associated with a significantly increased risk of biochemical progression on univariate analysis (HR 1.52, 95% CI 1.16-2.00, p = 0.002). However, after adjusting for clinical and pathological characteristics, black race was not an independent predictor of biochemical progression (HR 1.09, 95% CI 0.81-1.45, p = 0.578).
  
  
  CONCLUSIONS
  Black men were more likely to be obese and present with adverse preoperative clinical features at a younger age, and have a higher rate of biochemical progression. However, on multivariate analysis black race was not an independent predictor of adverse pathological outcome or biochemical recurrence. Further efforts are needed to detect prostate cancer earlier among black men.
authors.affiliation: Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.forename: Misop
authors.initials: M
authors.lastname: Han
authors.forename: Leslie
authors.initials: L
authors.lastname: Mangold
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Humphreys
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D001741:Black or African American; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012017:Referral and Consultation; D044465:White People