Race is not a predictor of prostate cancer detection on repeat prostate biopsy.

PURPOSE

We evaluated men undergoing repeat prostate biopsies for persistently increased serum prostate specific antigen (PSA) levels to determine if race was a predictor of cancer detection.

MATERIALS AND METHODS

Between July 1995 and June 2002, 401 men had undergone 2 or more transrectal ultrasound guided prostate biopsies at our institutions. Clinical information was gathered using our prostate biopsy database and retrospectively reviewed. Race, age, serum PSA, PSA velocity, total number of biopsies performed, total number of previous negative cores and the presence of high grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on prior biopsy were evaluated to determine if they were predictors of subsequent cancer detection. Multivariate analysis was performed using a time dependent covariate Cox proportional hazards model.

RESULTS

Of the 401 men undergoing repeat prostate biopsy, 91 (22.7%) were diagnosed with prostate cancer. In total there were 180 (44.9%) black men and 221 (55.1%) white men. Cancer was diagnosed in 49 black men (27.2%) and 42 white men (19.0%, p = 0.06). On multivariate analysis serum PSA, HGPIN, ASAP and PSA velocity were predictors of prostate cancer detection (p = 0.006, <0.0001, 0.001 and 0.0004, respectively). Race was not found to be a predictor of prostate cancer detection on repeat prostate biopsy (p = 0.16). In the evaluation of clinical data for racial differences, black men had a significantly higher incidence of HGPIN on prior biopsy compared to white men (p = 0.02). Serum PSA, PSA velocity, presence of ASAP on prior biopsy, age, number of biopsies performed and number of previous negative cores were not statistically different between black and white men.

CONCLUSIONS

Race is not a predictor of prostate cancer detection in men undergoing repeat prostate biopsies. With the exception of HGPIN, all other clinical parameters were similar between black and white men. Serum PSA, PSA velocity, HGPIN and ASAP were found to be significant predictors of subsequent prostate cancer detection.