Earlier prostate-specific antigen testing in African American men--Clinical support for the recommendation.
BACKGROUND
To determine whether prostate-specific antigen (PSA) testing in African American veterans (AAVs) aged 40 to 54 years is associated with high-risk prostate cancer characteristics compared with AAVs aged 55 to 70 years or white veterans (WVs) aged 40 to 54 years.


METHODS
A total of 231,174 healthy veterans aged 40 to 70 years without clinical evidence of prostate cancer underwent PSA testing between October 1, 2000, and September 30, 2007. Clinicopathologic tumor characteristics were available for 1,044/1,059 AAVs and 1,006/1,971 age-matched WVs diagnosed with prostate cancer after a PSA level>4 ng/ml triggered prostate biopsy. Tumor characteristics of AAVs aged 40 to 54 years were compared with AAVs 55 to 70 years, WVs 40 to 54 years, and WVs 55 to 70 years.


RESULTS
Of PSA-tested veterans aged 40 to 54 years diagnosed with prostate cancer, there were no racial differences in prebiopsy PSA levels, prostate cancer grade, or clinical stage at diagnosis. AAVs aged 40 to 54 years were more likely to have ≥ 3 positive cores (P = 0.0229) and were less likely to be active surveillance candidates (P = 0.0340) compared with similarly aged WVs. AAVs aged 55 to 70 years were more likely to have high-grade (P = 0.0204) and higher clinical stage (P = 0.0195) prostate cancer than AAVs aged 40 to 54 years.


CONCLUSIONS
This large national cohort study suggests that PSA testing at an earlier age for African American men may allow diagnosis of lower risk prostate cancer, potentially reducing disparate outcomes between AAVs and WVs.
Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA.
Amanda F
AF
Saltzman
Clinical Research and Epidemiology Workgroup, John Cochran Veterans Affairs Medical Center, St. Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO.
Suhong
S
Luo
Clinical Research and Epidemiology Workgroup, John Cochran Veterans Affairs Medical Center, St. Louis, MO; Department of Family and Community Medicine, Saint Louis University, St. Louis, MO.
Jeffery F
JF
Scherrer
Clinical Research and Epidemiology Workgroup, John Cochran Veterans Affairs Medical Center, St. Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO.
Kenneth D
KD
Carson
Clinical Research and Epidemiology Workgroup, John Cochran Veterans Affairs Medical Center, St. Louis, MO; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
Robert L
RL
Grubb
Clinical Research and Epidemiology Workgroup, John Cochran Veterans Affairs Medical Center, St. Louis, MO; Department of Urology, Diagnostic Clinic of Longview, Longview, TX. Electronic address: hudsonmls@aol.com.
M'Liss A
MA
Hudson
D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D001706:Biopsy; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000208:ethnology*; D012042:Registries; D012189:Retrospective Studies; D014728:Veterans; D044465:White People / Q000208:ethnology
D017430:Prostate-Specific Antigen
African American men; Prostate cancer; Prostate-specific antigen