Racial variations in the performance of prostate specific antigen and prostate specific antigen density in the era of extended prostate biopsy schemes.
OBJECTIVE
The incidence of prostate cancer is known to vary as a function of race. To date few studies have evaluated the performance of the prostate specific antigen test and its indexes in unique racial populations. We examined the performance of prostate specific antigen, prostate specific antigen density and transition zone density in racial groups undergoing an extended prostate biopsy scheme.


METHODS
A retrospective review was performed of prospectively collected data on 1,115 white, 288 black and 161 Asian/Pacific Islander men referred for prostate needle biopsy. All participants had not undergone previous biopsy. ROC curves stratified by race were ascertained for prostate specific antigen, prostate specific antigen density and transition zone density for detecting cancer and high grade cancer (Gleason 3 + 4 or greater).


RESULTS
Across all races prostate specific antigen density outperformed prostate specific antigen for detecting any prostate cancer and high grade cancer. Prostate specific antigen and prostate specific antigen density performed best for diagnosing high grade cancer and diagnosing cancer in men with an abnormal digital rectal examination. When comparing differing races, prostate specific antigen density performed the best in Asian/Pacific Islander men for high grade cancer detection. The performance of transition zone density was inferior to that of prostate specific antigen density.


CONCLUSIONS
Racial variations exist in the performance of prostate specific antigen and prostate specific antigen density. In men of Asian/Pacific Islander descent prostate specific antigen and prostate specific antigen density perform better than in white men, especially for diagnosing clinically significant, high grade prostate cancer. In general prostate specific antigen and prostate specific antigen density perform equally well in white and black populations.
Elliott
Christopher S
CS
Department of Urology, Stanford University School of Medicine, California 94305-5118, USA. chrsuz@aol.com
Shinghal
Rajesh
R
Presti
Joseph C
JC
D000368:Aged; D019540:Area Under Curve; D044466:Asian People / Q000706:statistics & numerical data; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D044383:Black People / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000208:ethnology* / Q000473:pathology; D012372:ROC Curve; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D044465:White People / Q000706:statistics & numerical data
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen