Moul J W, Connelly R R, Mooneyhan R M, Zhang W, Sesterhenn I A, Mostofi F K, McLeod D G
Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
J Urol. 1999 Aug;162(2):394-7.
Black men with and without prostate cancer in general have higher prostate specific antigen (PSA) before screening and treatment than other racial groups. A preliminary study suggested that higher PSA levels may be primarily due to greater tumor burden. We compared PSA and 3-dimensional (D) tumor volume in a consecutive cohort of black and white radical prostatectomy patients in an equal access military health care setting to determine racial differences in these parameters.
Prospective data collection, 2.25 mm. step section whole mount specimen processing and 3-D tumor volume assessment were performed in 226 patients with clinical stage T1-T3 prostate cancer undergoing radical prostatectomy at our center between April 1993 and March 1997. Of the patients 25 were excluded from further analysis because of neoadjuvant hormone treatment, T3 disease or Asian race. A total of 155 white and 46 black patients were compared.
There was no significant racial difference in the distribution of patients by age, clinical stage, pathological stage, Gleason sum or benign prostate gland volume. A significant racial difference was noted for pretreatment PSA and 3-D tumor volume. PSA values were higher in black men than in white men, and the racial difference remained statistically significant in multivariate analysis adjusting for 3-D tumor volume, benign gland volume, age, stage and Gleason sum.
Racial difference in PSA persists, despite rigorous covariate adjustment, and further study is needed to explain this PSA difference.
一般而言，患有和未患前列腺癌的黑人在筛查和治疗前的前列腺特异性抗原（PSA）水平高于其他种族群体。一项初步研究表明，较高的PSA水平可能主要归因于更大的肿瘤负荷。我们在平等获得军事医疗保健的环境中，比较了连续队列中接受根治性前列腺切除术的黑人和白人患者的PSA和三维（3D）肿瘤体积，以确定这些参数中的种族差异。
对1993年4月至1997年3月期间在我们中心接受根治性前列腺切除术的226例临床分期为T1 - T3前列腺癌患者进行前瞻性数据收集、2.25毫米步距切片全标本处理和3D肿瘤体积评估。其中25例患者因新辅助激素治疗、T3期疾病或亚洲种族被排除在进一步分析之外。共比较了155例白人患者和46例黑人患者。
在患者按年龄、临床分期、病理分期、Gleason评分或良性前列腺体积的分布上，没有显著的种族差异。在治疗前的PSA和3D肿瘤体积方面，观察到显著的种族差异。黑人男性的PSA值高于白人男性，在对3D肿瘤体积、良性腺体体积、年龄、分期和Gleason评分进行多变量分析时，种族差异仍具有统计学意义。
尽管进行了严格的协变量调整，PSA的种族差异仍然存在，需要进一步研究来解释这种PSA差异。
