Should African‐American men be tested for prostate carcinoma at an earlier age than white men?

• Published in: Cancer Vol. 85; no. 2; pp. 472 - 477
• Main Authors: Powell, Isaac J., Banerjee, Mousumi, Sakr, Wael, Grignon, David, Wood, David P., Novallo, Mary, Pontes, Edson
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York John Wiley & Sons, Inc 15-01-1999; Wiley-Liss
• Subjects: African Americans; age factor; Age Factors; Aged; Biological and medical sciences; European Continental Ancestry Group; Humans; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Nephrology. Urinary tract diseases; Outcome Assessment (Health Care); Prostate; prostate carcinoma; Prostatectomy; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - surgery; racial differences; Survival Analysis; Tumors of the urinary system; Urinary tract. Prostate gland; United States; North America; America; Human; Urinary system disease; Carcinoma; Prognosis; Prostate disease; Malignant tumor; Medical screening; Ethnic group; Race; Black American; Male genital diseases; Prostate; Public health; Age
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19990115)85:2<472::AID-CNCR27>3.0.CO;2-0

BACKGROUND
There have recently been challenges to testing high risk populations, i.e., African‐American men younger than 50 years, for prostate carcinoma (PCa). The mortality rate of patients with PCa between ages 40 and 60 years is nearly 3 times greater among African‐American men (AAM) compared with white men (WM). The literature in support of testing AAM at an earlier age than WM is sparse. Therefore, the authors present clinical and histologic data that support the testing of AAM at a younger age, utilizing data on patients with clinically localized PCa.
METHODS
Examination of consecutive radical prostatectomy specimens from AAM and WM was performed from January 1991 to June 1996 among AAM and WM at Wayne State University, Harper Hospital, Detroit, Michigan. International, salvage prostatectomy, and neoadjuvant hormonal therapy patients were excluded, as were patients with lymph node metastasis. The authors examined biochemical recurrences of PCa in this cohort of men treated from January 1991 through December 1995. Univariate analysis of contingency tables was performed, using chi‐squared‐tests to assess the correlation between stage and race after stratification of patients by age group. Biochemical recurrence was analyzed using the Kaplan–Meier method and the log rank test.
RESULTS
The authors examined radical prostatectomy specimens from 759 patients and biochemical recurrence outcome of 655 patients. AAM patients ages 50–69 years had higher prostate specific antigen levels, worse Gleason scores, more advanced stages of disease, and a higher recurrence rate. However, among men ages70–79 years, there was no difference in these parameters between AAM and WM. Among men ages 40–49 years, a larger sample size is necessary to make meaningful comparisons.
CONCLUSIONS
Data on the outcomes of men treated for clinically localized PCa demonstrated more advanced disease and more frequent recurrence among young AAM than among WM, young and of advanced age. These differences in disease severity and recurrence, in addition to the disproportionate mortality among young AAM, are strong evidence that AAM should be tested for PCa at an earlier age than WM. Cancer 1999;85:472–7. © 1999 American Cancer Society.
Data on the outcomes of men treated for clinically localized prostate carcinoma demonstrate more advanced disease and greater recurrence among young African‐American men compared with white men, both young and of advanced age. These differences in disease severity and recurrence, in addition to the disproportionate mortality among young African‐American men, are strong evidence that African‐American men should be tested for prostate carcinoma at an earlier age than white men.