title: Racial variation in prostate needle biopsy templates directed anterior to the peripheral zone.
abstract: African Americans (AA) have been reported to have both increased incidence and increased aggressiveness of prostate cancer (PCa) located anterior to the peripheral zone (APZ). We sought to evaluate the utility of prostate biopsies directed toward the APZ in a predominantly AA cohort.
  
  
  
  We reviewed all patients with PCa found on biopsy schema that included needle biopsies directed at both the peripheral zone (PZ) and APZ from 2010 to 2014. Self-identified race was recorded for all patients. To evaluate the reliability of APZ-directed prostate biopsies, we performed pathologic secondary review of 25 radical prostatectomy specimens. A series of the Mann-Whitney U and Chi-square tests were used to compare variables.
  
  
  
  We identified 398 men, of which 277 (70%) were AA. Compared with non-AA, AA had more National Comprehensive Cancer Network-defined intermediate or high-risk (50% vs. 39%, P = 0.25) PCa. Most patients had PCa limited to the PZ only (n = 190) or in both the PZ and APZ (n = 191). For 17 patients (4%), PCa was limited only to the APZ core(s), 14 (5%) AA vs. 3 (2%) non-AA (P = 0.24). Most of these 17 patients (n = 14, 82%) had Gleason 6 disease. Patients with PCa in both the PZ and APZ had higher serum prostate-specific antigen, prostate-specific antigen density, volume of disease, and increased grade and National Comprehensive Cancer Network category (all P<0.01). Of these patients, there were no differences in race (AA = 135, 71% vs. non-AA = 56, 29%; P = 0.48). In only 21 men (11%), without racial variation, APZ tumor grade was greater than PZ. Radical prostatectomy and APZ-directed biopsies demonstrated a concordance rate of 80% (20/25), false positive rate of 8% (2/25), and false negative rate of 12% (3/25).
  
  
  
  APZ-directed prostate biopsies are rarely the sole location of PCa and do not show a clear racial predilection. In those men with PCa identified in both regions, the APZ biopsy did not frequently change treatment recommendations. Biopsies directed at the APZ are not of greater benefit to AA than non-AA.
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA.
authors.forename: Allison H
authors.initials: AH
authors.lastname: Feibus
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Justin
authors.initials: J
authors.lastname: Levy
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: McCaslin
authors.affiliation: Department of Pathology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Meggie E
authors.initials: ME
authors.lastname: Doucet
authors.affiliation: Department of Pathology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Sholl
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA.
authors.forename: Krishnarao
authors.initials: K
authors.lastname: Moparty
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA.
authors.forename: Raju
authors.initials: R
authors.lastname: Thomas
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Sartor
authors.affiliation: Department of Urology, Tulane University School of Medicine, New Orleans, LA; Southeast Louisiana Veterans Health Care Services, New Orleans, LA. Electronic address: jsilbers@tulane.edu.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Silberstein
mesh_terms: D001741:Black or African American; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D015203:Reproducibility of Results
chemical_list: D017430:Prostate-Specific Antigen
keywords: African American; Anterior to peripheral zone; Prostate biopsy; Prostate cancer; Racial variation