Racial Differences in a Prostate Cancer Screening Study

Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
The Journal of Urology (Impact Factor: 3.75). 11/1996; 156(4):1366-9. DOI: 10.1016/S0022-5347(01)65588-5
Source: PubMed

ABSTRACT We attempted to determine whether black men have a higher prostate cancer prevalence and more advanced disease.
We screened 17,157 white and 804 black men 50 years old or older by serum prostate specific antigen measurement and digital rectal examination. We recommended biopsy when either test was suspicious.
Black men had a higher prevalence of elevated prostate specific antigen (13.1 versus 8.9%) and cancer (5.1 versus 3.2%) than white men, and a higher prevalence of clinically but not pathologically advanced cancer. Fewer black men in lower income zip codes complied with recommendations for biopsy.
In our screening study black men had a higher prevalence of detectable cancer. However, unlike in clinical studies there was no striking racial difference in advanced cancer stage at diagnosis.

  • Source
    • "However, there are disparities with PSA screening in the United States; African Americans are less likely to undergo PSA screening than are Whites. Researchers previously reported a higher rate of elevated PSA (greater than 4.0 ng/ml) and a higher prostate cancer detection rate in African Americans than in White men in a community-based screening study [4]. Yet little is known about PSA screening behaviors and factors affecting those behaviors. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to investigate social and behavioral factors associated with prostate-specific antigen (PSA) screening in men in California, United States, who were over 40 years of age and had ever heard about PSA screening. This survey was administered as a random-digit-dialing telephone survey to produce reliable estimates of medium-sized counties. It surveyed 42,000 households and interviewed 58,407 people randomly. It considered socioeconomic status and health behavior as affecting PSA screening. Access to health care was measured as having regular health care access. The main outcome measure was self-report of ever having undergone PSA screening at least once in the respondent's lifetime. Of 8,864 respondents, 82.2% were White, 7.7% were Latin, 4.2% were African American, and 5.9% were Asian. The respondents' mean age was 60.13 years. Age was the significant factor for PSA screening. Respondents aged 50-59 years were 3.5 times as likely to have undergone PSA screening as were those aged 40-49 years (OR=3.49, p</=0.001). Race was not statistically significant after considering other factors. People who had never married had statistically significantly lower screening than did people who were married (OR=0.71, p=0.001). Poverty levels were statistically significant in both the unadjusted and the adjusted analysis. People who had no regular health care access were much less likely to have undergone PSA screening than were people who had regular health care access (OR=0.22, p=0.001). The likelihood of PSA screening was positively associated with increased age, marital status (married), higher socioeconomic status (higher federal poverty level and higher educational attainment), and health care access. However, there was no statistically significant association of PSA screening with race, employment, exercise, smoking, or drinking status.
    Korean journal of urology 06/2010; 51(6):391-7. DOI:10.4111/kju.2010.51.6.391
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the U.S., the number of prostate biopsies increases annually. This is partly due to elevated prostate specific antigen (PSA) values identified during PC screening. This study's goal was improving prostate cancer (PC) detection through developing a clinical decision rule (CDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after an elevated PSA, providing the patient and clinician information to consider prior to biopsy. This cross-sectional study evaluated men from the Tampa, Florida, James A. Haley (JH) VA (N=1,378), from January 1, 1998, through April 15, 2005. The study hypothesized that specific lab biomarkers among JH VA PC cases would differ significantly from JH VA patients without PC. The following biomarkers were related to PC: hemoglobin (HGB) (OR=1.42 95%CI 1.27, 1.59); red blood cell count (RBC) (OR=2.52 95%CI 1.67, 3.78); PSA (OR=1.04 95%CI 1.03, 1.05); and, creatinine (OR=1.55 95%CI 1.12, 2.15). This study attempted to determine whether including specific biomarkers (that are related to systemic diseases associated with advancing PC) could improve PC prediction (versus PSA alone). Comparing all PC stages versus non-cancerous conditions, the Receiver Operator Characteristic (ROC) curve area under the curve (AUC) expanded (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); CDR model 0.68 (95%CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; CDR model 61.8%. Comparing PC (stages B, C, D) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); CDR model 0.68 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); CDR model 55.3%. These results suggest evaluating certain biomarkers might improve PC prediction prior to biopsy. Moreover, the biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA data-sets involving multiple practices.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Benign prostatic hyperplasia (BPH) is an ever present threat to aging men. The gradual demographic shift of the population of the western world appears to be towards the elderly. The increasing burden on both individuals and the healthcare system, therefore, is going to increase in the foreseeable future. Although BPH is not a life-threatening condition, it can have serious consequences on the normal function of the lower urinary tracts. The overlap in terms of presentation exists with malignant prostatic disease and this needs to be considered when investigating these patients. The morbidity caused by BPH should not be underestimated for the sufferer, especially where there are ready treatments available and the opportunity to exclude other even more serious conditions. This article reviews the latest publications and papers looking at diagnosis and, in particular, identifying those at risk, the assessment of severity using symptom scores and discussing the methods and effectiveness of the various investigative tools. Controversy exists over the role of prostate-specific antigen (PSA) in detecting prostate cancer and the role of urodynamics versus symptom scores in the treatment and assessment of BPH patients with lower urinary tract symptoms. Investigations include the blood test for PSA to pick up those with carcinoma of the prostate, in addition, urodynamic studies, in particular flow rate and post-void residual volume, can diagnose and assess the severity of bladder outflow obstruction, assess and help exclude causes other than BPH.
    Disease Management and Health Outcomes 01/1997; 2(4):178-188. DOI:10.2165/00115677-199702040-00002 · 0.35 Impact Factor
Show more