The impact of race on prostate cancer detection and choice of treatment in men undergoing a contemporary extended biopsy approach.

INTRODUCTION: African American men have a higher rate of prostate cancer mortality compared with their Caucasian American counterparts. However, it remains unclear as to whether such differences are due to biologic or socioeconomic influences. This study sought to determine if there are differences in demographic and clinical characteristics between African American and Caucasian American men in a modern cohort undergoing extended biopsy approach, and evaluated the subsequent choice of therapy in patients diagnosed with prostate cancer.

METHODS: A retrospective review was performed from a consecutive series of 500 men undergoing prostate biopsy at our institution between 2003 and 2005. All patients underwent a contemporary 10-12 biopsy scheme. Demographic, clinical, and pathologic variables as well as treatment choice (those with positive biopsy) were stratified and evaluated with regard to race-African American, Caucasian American, and other (Hispanic, Asian, American Indian).

RESULTS: 65% were Caucasian American, 29% African American, and 7% other. The overall positive biopsy rate was 44%. African American men were significantly younger than Caucasian American but were not younger than "other" (61.6 vs. 64.3 vs. 61.5 years). No differences were observed with regard to prostate specific antigen density (PSAD), prostate volume, or rate of abnormal digital rectal exam (DRE). The positive biopsy rate was not different between Caucasian American and African American (46% vs. 46%), but significantly lower in other men (16%). These differences were maintained on odds ratio modeling, including age-adjusted and multivariate models. Of the 223 men with positive biopsies, information on treatment choice demonstrated that African American men had a significantly higher rate of choice of XRT (OR = 2.12) and rate of avoidance of surgery (OR = 0.35) than Caucasian American men.

CONCLUSIONS: In men undergoing prostate biopsy using an extended (10-12 core) biopsy scheme, no differences were observed with regard to positive biopsy rate or other clinical or biochemical parameters [except for age and prostate specific antigen (PSA) level] between African American and Caucasian American men. Of those with a positive biopsy, African American men were more likely to avoid surgery and choose XRT in our population.