title: The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort.
abstract: OBJECTIVE
  Population-based studies have established a link between race and prostate cancer (PC) risk, but whether race predicts PC after adjusting for clinical characteristics is unclear. We investigated the association between race and risk of low- and high-grade PC in men undergoing initial prostate biopsy in an equal access medical center.
  
  
  METHODS
  We conducted a retrospective record review of 887 men (48.6 % black, 51.4 % white) from the Durham Veterans Affairs Medical Center who underwent initial prostate biopsy between 2001 and 2009. Multivariable logistic regression analysis of race and biopsy outcome was conducted adjusting for age, body mass index, number of cores taken, prostate-specific antigen (PSA), and digital rectal examination findings. Multinomial logistic regression was used to test the association between black race and PC grade (Gleason <7 vs. ≥7).
  
  
  RESULTS
  Black men were younger at biopsy (61 vs. 65 years, p < 0.001) and had a higher pre-biopsy PSA (6.6 vs. 5.8 ng/ml, p = 0.001). A total of 499 men had PC on biopsy (245 low grade; 254 high grade). In multivariable analyses, black race was significantly predictive of PC overall [odds ratio 1.50, p = 0.006] and high-grade PC [relative risk ratio (RRR) 1.84, p = 0.001], but was not significantly associated with low-grade PC (RRR 1.29, p = 0.139).
  
  
  CONCLUSIONS
  In an equal access healthcare facility, black race was associated with greater risk of PC detection on initial biopsy and of high-grade PC after adjusting for clinical characteristics. Additional investigation of mechanisms linking black race and PC risk and PC aggressiveness is needed.
authors.affiliation: Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Gaines
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Turner
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Moorman
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Keto
authors.forename: Megan E
authors.initials: ME
authors.lastname: McPhail
authors.forename: Delores J
authors.initials: DJ
authors.lastname: Grant
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Vidal
authors.forename: Cathrine
authors.initials: C
authors.lastname: Hoyo
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D044383:Black People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology; D012189:Retrospective Studies; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American