Current age and race adjusted prostate specific antigen threshold values delay diagnosis of high grade prostate cancer.
OBJECTIVE
Age specific prostate specific antigen ranges have been advocated to increase the predictive value of prostate specific antigen based on increases that occur with aging. We suggest that prostate specific antigen is not a dichotomous biomarker and age specific reference ranges delays the diagnosis of high grade prostate cancer in older and black American men.


METHODS
Using the Prostate Cancer Prevention Trial risk calculator we evaluated the impact of age on the risk of high grade prostate cancer in white and black men. We created a hypothetical population of men by standardizing risk variables, including negative family history, normal digital rectal examination and no history of negative biopsy. Results were compared in the 2 populations using 5-year age increments from ages 55 to 75 years and increasing prostate specific antigen.


RESULTS
Increasing age was associated with a higher risk of high grade prostate cancer in white and black men. The risk of high grade prostate cancer in a black man was twice that in a white man with the same prostate specific antigen at all prostate specific antigen values.


CONCLUSIONS
Age specific and race specific prostate specific antigen ranges are flawed. Many patients who would not be considered for biopsy based on these prostate specific antigen ranges are at significant risk for high grade prostate cancer. The risk of high grade prostate cancer in black men is twice that in white men. Risk assessment in black men and older men is necessary to diagnose high grade prostate cancer when treatment can be effective.
Reed
Amanda
A
Department of Urology, University of Texas Health Sciences Center-San Antonio, San Antonio, Texas 78229, USA.
Ankerst
Donna P
DP
Pollock
Brad H
BH
Thompson
Ian M
IM
Parekh
Dipen J
DJ
D001741:Black or African American; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000208:ethnology* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen