Cancer Causes & Control

, Volume 25, Issue 8, pp 1029–1035 | Cite as

The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort

  • Alexis R. Gaines
  • Elizabeth L. Turner
  • Patricia G. Moorman
  • Stephen J. Freedland
  • Christopher J. Keto
  • Megan E. McPhail
  • Delores J. Grant
  • Adriana C. Vidal
  • Cathrine HoyoEmail author
Original paper



Population-based studies have established a link between race and prostate cancer (PC) risk, but whether race predicts PC after adjusting for clinical characteristics is unclear. We investigated the association between race and risk of low- and high-grade PC in men undergoing initial prostate biopsy in an equal access medical center.


We conducted a retrospective record review of 887 men (48.6 % black, 51.4 % white) from the Durham Veterans Affairs Medical Center who underwent initial prostate biopsy between 2001 and 2009. Multivariable logistic regression analysis of race and biopsy outcome was conducted adjusting for age, body mass index, number of cores taken, prostate-specific antigen (PSA), and digital rectal examination findings. Multinomial logistic regression was used to test the association between black race and PC grade (Gleason <7 vs. ≥7).


Black men were younger at biopsy (61 vs. 65 years, p < 0.001) and had a higher pre-biopsy PSA (6.6 vs. 5.8 ng/ml, p = 0.001). A total of 499 men had PC on biopsy (245 low grade; 254 high grade). In multivariable analyses, black race was significantly predictive of PC overall [odds ratio 1.50, p = 0.006] and high-grade PC [relative risk ratio (RRR) 1.84, p = 0.001], but was not significantly associated with low-grade PC (RRR 1.29, p = 0.139).


In an equal access healthcare facility, black race was associated with greater risk of PC detection on initial biopsy and of high-grade PC after adjusting for clinical characteristics. Additional investigation of mechanisms linking black race and PC risk and PC aggressiveness is needed.


Prostate cancer Risk Initial biopsy Race Equal access 



Body mass index (kg/m2)


Confidence interval


Digital rectal exam


Durham Veterans Affairs Medical Center


Interquartile range


Odds ratio


Relative risk ratio


p value


prostate cancer


prostate specific antigen (ng/mL)



We would like to acknowledge L. Gerber for her assistance in maintaining the database used for this study.

Conflict of interest

The authors have no actual or potential conflict of interest in relation to this manuscript.


  1. 1.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63(1):11–30. doi: 10.3322/caac.21166 PubMedCrossRefGoogle Scholar
  2. 2.
    Brawley OW, Knopf K, Thompson I (1998) The epidemiology of prostate cancer part II: the risk factors. Semin Urol Oncol 16(4):193–201PubMedGoogle Scholar
  3. 3.
    Freedland SJ, Isaacs WB (2005) Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 62(3):243–252. doi: 10.1002/pros.20052 PubMedCrossRefGoogle Scholar
  4. 4.
    Thomas G, Jacobs KB, Yeager M, Kraft P, Wacholder S, Orr N, Yu K, Chatterjee N, Welch R, Hutchinson A, Crenshaw A, Cancel-Tassin G, Staats BJ, Wang Z, Gonzalez-Bosquet J, Fang J, Deng X, Berndt SI, Calle EE, Feigelson HS, Thun MJ, Rodriguez C, Albanes D, Virtamo J, Weinstein S, Schumacher FR, Giovannucci E, Willett WC, Cussenot O, Valeri A, Andriole GL, Crawford ED, Tucker M, Gerhard DS, Fraumeni JF Jr, Hoover R, Hayes RB, Hunter DJ, Chanock SJ (2008) Multiple loci identified in a genome-wide association study of prostate cancer. Nat Genet 40(3):310–315. doi: 10.1038/ng.91 PubMedCrossRefGoogle Scholar
  5. 5.
    Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, Partin AW (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294(4):433–439PubMedCrossRefGoogle Scholar
  6. 6.
    Johnstone PA, Kane CJ, Sun L, Wu H, Moul JW, McLeod DG, Martin DD, Kusuda L, Lance R, Douglas R, Donahue T, Beat MG, Foley J, Baldwin D, Soderdahl D, Do J, Amling CL (2002) Effect of race on biochemical disease-free outcome in patients with prostate cancer treated with definitive radiation therapy in an equal-access health care system: radiation oncology report of the department of defense center for prostate disease research. Radiology 225(2):420–426PubMedCrossRefGoogle Scholar
  7. 7.
    Fowler JE Jr, Terrell F (1996) Survival in blacks and whites after treatment for localized prostate cancer. J Urol 156(1):133–136PubMedCrossRefGoogle Scholar
  8. 8.
    Roach M III, Lu J, Pilepich MV, Asbell SO, Mohiuddin M, Grignon D (2003) Race and survival of men treated for prostate cancer on radiation therapy oncology group phase III randomized trials. J Urol 169(1):245–250PubMedCrossRefGoogle Scholar
  9. 9.
    Powell IJ, Schwartz K, Hussain M (1995) Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? A comparative study between black and white men in a Veterans Affairs system. Urology 46(6):825–830. doi: 10.1016/S0090-4295(99)80352-5 PubMedCrossRefGoogle Scholar
  10. 10.
    Hamilton RJ, Aronson WJ, Presti JC Jr, Terris MK, Kane CJ, Amling CL, Freedland SJ (2007) Race, biochemical disease recurrence, and prostate-specific antigen doubling time after radical prostatectomy: results from the SEARCH database. Cancer 110(10):2202–2209Google Scholar
  11. 11.
    Yanke BV, Carver BS, Bianco FJ Jr, Simoneaux WJ, Venable DD, Powell IJ, Eastham JA (2006) African-American race is a predictor of prostate cancer detection: incorporation into a pre-biopsy nomogram. BJU Int 98(4):783–787. doi: 10.1111/j.1464-410X.2006.06388.x PubMedCrossRefGoogle Scholar
  12. 12.
    Kubricht WS, Kattan MW, Sartor O, Eastham JA (1999) Race is not independently associated with a positive prostate biopsy in men suspected of having prostate cancer. Urology 53(3):553–556PubMedCrossRefGoogle Scholar
  13. 13.
    Tsivian M, Banez LL, Keto CJ, Abern MR, Qi P, Gerber L, Moul JW, Polascik TJ (2012) African-American men with low-grade prostate cancer have higher tumor burdens: results from the Duke Prostate Center. Prostate Cancer Prostatic Dis. doi: 10.1038/pcan.2012.39 Google Scholar
  14. 14.
    Polednak AP (2002) Black-white differences in tumor grade (aggressiveness) at diagnosis of prostate cancer, 1992–1998. Ethn Dis 12(4):536–540PubMedGoogle Scholar
  15. 15.
    US Department of Veterans Affairs (2013) About the Durham Veterans Affairs Medical Center. US Department of Veterans Affairs, Washington, DCGoogle Scholar
  16. 16.
    US Department of Veterans Affairs (2012) Health benefits: veteran eligibility. US Department of Veterans Affairs, Washington, DCGoogle Scholar
  17. 17.
    US Census Bureau (2011) American Community Survey, public use microdata sample (PUMS). US Department of Commerce, Washington, DCGoogle Scholar
  18. 18.
    Department of Defense (2011) Population representation in the military services fiscal year 2011 report. Washington, DCGoogle Scholar
  19. 19.
    Zullig LL, Jackson GL, Dorn RA, Provenzale DT, McNeil R, Thomas CM, Kelley MJ (2012) Cancer incidence among patients of the U.S. Veterans Affairs Health Care System. Mil Med 177(6):693–701PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM (2000) Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med 160(21):3252–3257PubMedCrossRefGoogle Scholar
  21. 21.
    Moreira DM, Anderson T, Gerber L, Thomas JA, Banez LL, McKeever MG, Hoyo C, Grant D, Jayachandran J, Freedland SJ (2011) The association of diabetes mellitus and high-grade prostate cancer in a multiethnic biopsy series. Cancer Causes Control 22(7):977–983. doi: 10.1007/s10552-011-9770-3 PubMedCrossRefGoogle Scholar
  22. 22.
    Pierorazio PM, Walsh PC, Partin AW, Epstein JI (2013) Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 111(5):753–760. doi: 10.1111/j.1464-410X.2012.11611.x PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Howlader NNA, Krapcho M et al (2013) SEER cancer statistics review, 1975–2010. National Cancer Institute, BethesdaGoogle Scholar
  24. 24.
    Odedina FT, Akinremi TO, Chinegwundoh F, Roberts R, Yu D, Reams RR, Freedman ML, Rivers B, Green BL, Kumar N (2009) Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa. Infect Agents cancer 4(Suppl. 1):S2. doi: 10.1186/1750-9378-4-S1-S2 PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Powell IJ (2007) Epidemiology and pathophysiology of prostate cancer in African-American men. J Urol 177(2):444–449. doi: 10.1016/j.juro.2006.09.024 PubMedCrossRefGoogle Scholar
  26. 26.
    Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, Feng Z, Parnes HL, Coltman CA Jr (2006) Assessing prostate cancer risk: results from the prostate cancer prevention trial. J Natl Cancer Inst 98(8):529–534. doi: 10.1093/jnci/djj131 PubMedCrossRefGoogle Scholar
  27. 27.
    Gann PH, Fought A, Deaton R, Catalona WJ, Vonesh E (2010) Risk factors for prostate cancer detection after a negative biopsy: a novel multivariable longitudinal approach. J Clin Oncol 28(10):1714–1720. doi: 10.1200/JCO.2008.20.3422 PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Carver BS, Bozeman CB, Simoneaux WJ, Venable DD, Kattan MW, Eastham JA (2004) Race is not a predictor of prostate cancer detection on repeat prostate biopsy. J Urol 172(5 Pt 1):1853–1855PubMedCrossRefGoogle Scholar
  29. 29.
    Bennett CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, Seday MA, Sartor O (1998) Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. J Clin Oncol 16(9):3101–3104PubMedGoogle Scholar
  30. 30.
    US Preventive Services Task Force (2012) Screening for prostate cancer: final recommendation statement. AHRQ Publication No. 12-05160-EF-2. (Accessed June 2013)
  31. 31.
    Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, Holmberg L, Kantoff P, Konety BR, Murad MH, Penson DF, Zietman AL (2013) Early detection of prostate cancer: AUA guideline. J Urol 190(2):419–426. doi:  10.1016/j.juro.2013.04.119
  32. 32.
    Carpenter WR, Beskow LM, Blocker DE, Forlenza MJ, Kim AE, Pevzner ES, Rose JM, Tran AN, Webber KH, Knight K, O’Malley MS (2008) Towards a more comprehensive understanding of cancer burden in North Carolina: priorities for intervention. N C Med J 69(4):275–282PubMedCentralPubMedGoogle Scholar
  33. 33.
    Porterfield D, Knight K (2006) Running the numbers: a periodic feature to inform North Carolina healthcare professionals about current topics in health statistics. N C Med J 67(3):235–236Google Scholar
  34. 34.
    Nixon RG, Meyer GE, Brawer MK (1999) Differences in prostate size between patients from university and Veterans Affairs Medical Center populations. Prostate 38(2):144–150PubMedCrossRefGoogle Scholar
  35. 35.
    Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8 Suppl.):IV-3–IV-18. doi: 10.1097/01.MLR.0000020942.47004.03 Google Scholar
  36. 36.
    Boyko EJ, Koepsell TD, Gaziano JM, Horner RD, Feussner JR (2000) US Department of Veterans Affairs medical care system as a resource to epidemiologists. Am J Epidemiol 151(3):307–314PubMedCrossRefGoogle Scholar
  37. 37.
    Du XL, Fang S, Coker AL, Sanderson M, Aragaki C, Cormier JN, Xing Y, Gor BJ, Chan W (2006) Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer 106(6):1276–1285. doi: 10.1002/cncr.21732 PubMedCrossRefGoogle Scholar
  38. 38.
    Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S (2008) Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med 23(5):654–671. doi: 10.1007/s11606-008-0521-4 PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Hsing AW, Chokkalingam AP (2006) Prostate cancer epidemiology. Front Biosci 11:1388–1413PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Alexis R. Gaines
    • 1
  • Elizabeth L. Turner
    • 1
    • 2
  • Patricia G. Moorman
    • 3
    • 4
  • Stephen J. Freedland
    • 4
    • 7
    • 8
    • 10
  • Christopher J. Keto
    • 6
  • Megan E. McPhail
    • 7
    • 8
  • Delores J. Grant
    • 9
  • Adriana C. Vidal
    • 3
    • 7
    • 8
  • Cathrine Hoyo
    • 3
    • 4
    • 5
    Email author
  1. 1.Global Health InstituteDuke UniversityDurhamUSA
  2. 2.Department of Biostatistics and BioinformaticsDuke UniversityDurhamUSA
  3. 3.Department of Obstetrics and Gynecology, Cancer Detection, Prevention and Control Program, Duke Cancer InstituteDuke UniversityDurhamUSA
  4. 4.Duke Cancer InstituteDuke UniversityDurhamUSA
  5. 5.Duke University School of NursingDurhamUSA
  6. 6.Department of Urologic SurgeryAkron General Medical CenterAkronUSA
  7. 7.Urology SectionVeterans Affairs Medical CenterDurhamUSA
  8. 8.Division of Urology, Department of Surgery, Duke Prostate CenterDuke University School of MedicineDurhamUSA
  9. 9.Department of Biology and Cancer Research Program, JLC-Biomedical/Biotechnology Research InstituteNorth Carolina Central UniversityDurhamUSA
  10. 10.Department of PathologyDuke University School of MedicineDurhamUSA

Personalised recommendations