Moul J W, Sesterhenn I A, Connelly R R, Douglas T, Srivastava S, Mostofi F K, McLeod D G
Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
JAMA. 1995 Oct 25;274(16):1277-81.
To determine if African-American men with newly diagnosed prostate cancer (PC) have higher pretreatment serum prostate-specific antigen (PSA) values after adjustment for clinical stage, age, and tumor grade, and to determine if any difference detected is related to tumor volume difference.
Consecutive case series of newly diagnosed PC patients between January 1990 and September 1994 and cohort analytic study of PC patients treated by radical prostatectomy (RP) and who had whole-mount pathologic tumor volume assessment between May 1993 December 1994.
Tertiary care military medical center.
A total of 541 evaluable newly diagnosed PC patients (408 white and 133 black) having pretreatment PSA assessment at one laboratory; 91 patients undergoing RP had whole-mount tumor volume analysis.
Medical record review for pretreatment PSA value, race, tumor grade, clinical stage, and age, as well as whole-mount pathologic assessment of RP specimen and measurement of tumor volume.
The PSA differences between black and white PC patients with adjustments for age, biopsy tumor grade (Gleason score), and clinical stage (TNM stage); PSA differences between black and white PC patients undergoing RP with adjustment for age, RP grade, clinical stage, and tumor volume.
The mean (geometric) PSA value for 133 black men was 14.00 ng/mL compared with 8.29 ng/mL for 408 white men (P < .001). The black patients had higher PSA values across all stage, grade, and age categories. The racial difference in PSA levels remained statistically significant when stage, grade, and age were simultaneously controlled for (P < .001). Multivariable odds ratio testing revealed that even after adjustment for stage, grade, and age, black patients were 2.2 times as likely as white patients to have a PSA value greater than 10.0 ng/mL (95% confidence interval, 1.3 to 3.6). Tumor volume (geometric mean) was 5.42 cm3 and 2.10 cm3 for black and white RP patients, respectively (P = .002). Across all clinical stages (T1a to T3), black men had tumor volumes 1.3 to 2.5 times greater than those of white men. Multivariable analysis of covariance revealed that tumor volume and stage of disease were important predictors of PSA level, but race, grade, and age were not. (The percentage of white and black patients whose cancer was detected by screening [75.4% vs 70.4%] or who had symptoms [37.7% vs 29.6%] was not significantly different.)
As a group, African-American men with newly diagnosed PC have higher PSA values at initial diagnosis than white men. This PSA difference appears to be due to larger tumor volumes within clinical (TNM) stage categories among black patients. Elevated PSA value was a surrogate for larger tumor volume in this cohort of black men. This stage-for-stage tumor volume disparity even in an equal-access health care environment should prompt further study of screening behavior and/or biological differences of PC in the black population.
确定新诊断为前列腺癌（PC）的非裔美国男性在调整临床分期、年龄和肿瘤分级后，其治疗前血清前列腺特异性抗原（PSA）值是否更高，并确定检测到的任何差异是否与肿瘤体积差异有关。
1990年1月至1994年9月新诊断PC患者的连续病例系列，以及1993年5月至1994年12月接受根治性前列腺切除术（RP）并进行全层病理肿瘤体积评估的PC患者的队列分析研究。
三级医疗军事医学中心。
共有541例可评估的新诊断PC患者（408例白人，133例黑人）在一个实验室进行了治疗前PSA评估；91例行RP的患者进行了全层肿瘤体积分析。
查阅病历以获取治疗前PSA值、种族、肿瘤分级、临床分期和年龄，以及对RP标本进行全层病理评估并测量肿瘤体积。
调整年龄、活检肿瘤分级（Gleason评分）和临床分期（TNM分期）后，黑人和白人PC患者之间的PSA差异；调整年龄、RP分级、临床分期和肿瘤体积后，接受RP的黑人和白人PC患者之间的PSA差异。
133例黑人男性的平均（几何）PSA值为14.00 ng/mL，而408例白人男性为8.29 ng/mL（P <.001）。黑人患者在所有分期、分级和年龄类别中PSA值均较高。当同时控制分期、分级和年龄时，PSA水平的种族差异仍具有统计学意义（P <.001）。多变量优势比测试显示，即使在调整分期、分级和年龄后，黑人患者PSA值大于10.0 ng/mL的可能性是白人患者的2.2倍（95%置信区间，1.3至3.6）。黑人和白人RP患者的肿瘤体积（几何平均值）分别为5.42 cm³和2.10 cm³（P =.002）。在所有临床分期（T1a至T3）中，黑人男性的肿瘤体积比白人男性大1.3至2.5倍。多变量协方差分析显示，肿瘤体积和疾病分期是PSA水平的重要预测因素，但种族、分级和年龄不是。（通过筛查检测出癌症的白人和黑人患者百分比[75.4%对70.4%]或有症状的患者百分比[37.7%对29.6%]无显著差异。）
总体而言，新诊断为PC的非裔美国男性在初始诊断时的PSA值高于白人男性。这种PSA差异似乎是由于黑人患者在临床（TNM）分期类别中的肿瘤体积较大。在这组黑人男性中，PSA值升高是肿瘤体积较大的替代指标。即使在平等获得医疗保健的环境中，这种逐期肿瘤体积差异也应促使对黑人人群中PC的筛查行为和/或生物学差异进行进一步研究。
