Racial differences in serum prostate‐specific antigen (PSA) doubling time, histopathological variables and long‐term PSA recurrence between African‐American and white American men undergoing radical prostatectomy for clinically localized prostate cancer
Authors: Tewari Ashutosh , Horninger Wolfgang , Badani Ketan K. , Hasan Mazen , Coon Steven , Crawford E. David , Gamito Eduard J. , Wei John , Taub David , Montie James , Porter Chris , Divine George W. , Bartsch Georg , Menon Mani 
Published: June 2005

In a multi‐institutional study authors from the USA and Austria attempt to determine if there are differences in several indices between African‐American and white men undergoing radical prostatectomy. They did not find race to be an independent risk factor for PSA recurrence, but found that other variables commonly associated with PSA recurrence are also important in African‐Americans.

Using data extracted from the Hospital Episodes database, authors from England describe national trends in radical nephrectomy between 1995 and 2002. They found a considerable increase in the annual number of radical nephrectomies, with an expected increase in the number of laparoscopic procedures. They also found a decrease in emergency admissions and length of hospital stay.

OBJECTIVE

To determine if there are significant differences in biochemical characteristics, biopsy variables, histopathological data, and rates of prostate‐specific antigen (PSA) recurrence between African‐American (AA) and white American (WA) men undergoing radical prostatectomy (RP), as AA men are twice as likely to die from prostate cancer than their white counterparts.

PATIENTS AND METHODS

We established a cohort of 1058 patients (402 AA, 646 WA) who had RP and were followed for PSA recurrence. Age, race, serum PSA, biopsy Gleason score, clinical stage, pathological stage, and PSA recurrence data were available for the cohort. The chi‐square test of proportions and t‐tests were used to assess basic associations with race, and log‐rank tests and Cox regression models for time to PSA recurrence. Forward stepwise variable selection was used to assess the effect on the risk of PSA recurrence for race, adjusted by the other variables added one at a time.

RESULTS

The AA men had higher baseline PSA levels, more high‐grade prostatic intraepithelial neoplasia (HGPIN) in the biopsy, and more HGPIN in the pathology specimen than WA men. The AA men also had a shorter mean (sd) PSA doubling time before RP, at 4.2 (4.7) vs 5.2 (5.9) years. However, race was not an independent predictor of PSA recurrence (P = 0.225). Important predictors for PSA recurrence in a multivariable model were biopsy HGPIN (P < 0.014), unilateral vs bilateral cancer (P < 0.006), pathology Gleason score and positive margin status (both P < 0.001).

CONCLUSIONS

This study indicates that while there are racial differences in baseline serum PSA and incidence of HGPIN, race is not an independent risk factor for PSA recurrence. Rather, other variables such as pathology Gleason score, bilateral cancers, HGPIN and margin positivity are independently associated with PSA recurrence. The PSA doubling time after recurrence may also be important, leading to the increased mortality of AA men with prostate cancer.