PSA, PSAD Less Predictive of Aggressive PCa in Black Men

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Study finds that PSA and PSAD indicated prostate cancer above Gleason score 6 for white men only.
Study finds that PSA and PSAD indicated prostate cancer above Gleason score 6 for white men only.

PSA and PSA density (PSAD) measurements are less predictive of prostate cancer (PCa) overall and aggressive disease in particular in black men undergoing repeat prostate biopsy within 5 years of an initial benign biopsy.

Researchers presented the new findings at the Genitourinary Cancers Symposium in Orlando, Florida.

“This highlights the need for more reliable indicators of aggressive prostate cancers for African American men considering repeat biopsy for a persistently elevated PSA,” Jonathan Silberstein, MD, of Tulane University School of Medicine in New Orleans, told Renal & Urology News.

Dr Silberstein and his colleagues performed a retrospective analysis of 209 patients, 127 black and 82 white (median age 66 and 67, respectively), visiting Tulane Medical Center and Southeast Louisiana Veterans Health Care Services in New Orleans during 2003 to 2015. No statistical differences were found initially between races in serum PSA, PSAD, and prostate volume assessed by transrectal ultrasound. For black and white men, respectively, mean serum PSA was 5.7 vs 5.27 ng/mL; PSAD 0.161 vs 0.148 ng/mL/cc; and prostate volume 50.64 vs 47.61 cc.

Upon repeat biopsy, 25.2% of black men and 17.1% of white men showed any PCa. “The majority of prostate cancers found were low grade (71%), and the patients were good candidates for active surveillance protocols,” Dr Silberstein noted.

A similar proportion of both groups had aggressive cancer (28.1% vs 28.6%, respectively). According to a multivariable model, PSA values correlated with PCa severity for white men only. Likewise, PSAD values more reliably indicated PCa in white patients. Higher PSAD values correlated with aggressive disease in white men, but only non-aggressive PCa in black men.

Study limitations included a small sample size and an inconsistent number of cores sampled during TRUS-guided biopsy.

See more coverage from the Genitourinary Cancers Symposium.

Reference

  1. Libby RS, Nguyen HMT, Kramer JJ, Feibus AH, Thomas R, and Silberstein JL. Racial variation in the reliability of prostate cancer indicators in men undergoing subsequent prostate biopsy. Data presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida, February 16-18, 2017. Poster Session B (Board #B9). Abstract: 115. 
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