The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort
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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.
KeywordsProstate cancer Risk Initial biopsy Race Equal access
Body mass index (kg/m2)
Digital rectal exam
Durham Veterans Affairs Medical Center
Relative risk ratio
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.
- 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
- 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
- 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.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
- 15.US Department of Veterans Affairs (2013) About the Durham Veterans Affairs Medical Center. US Department of Veterans Affairs, Washington, DCGoogle Scholar
- 16.US Department of Veterans Affairs (2012) Health benefits: veteran eligibility. US Department of Veterans Affairs, Washington, DCGoogle Scholar
- 17.US Census Bureau (2011) American Community Survey, public use microdata sample (PUMS). US Department of Commerce, Washington, DCGoogle Scholar
- 18.Department of Defense (2011) Population representation in the military services fiscal year 2011 report. Washington, DCGoogle Scholar
- 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
- 23.Howlader NNA, Krapcho M et al (2013) SEER cancer statistics review, 1975–2010. National Cancer Institute, BethesdaGoogle Scholar
- 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
- 30.US Preventive Services Task Force (2012) Screening for prostate cancer: final recommendation statement. AHRQ Publication No. 12-05160-EF-2. http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs.htm. (Accessed June 2013)
- 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
- 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
- 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