Prostate-specific antigen (PSA) and PSA density: racial differences in men without prostate cancer

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Serum prostate-specific antigen (PSA) is widely used for prostate cancer screening in asymptomatic men.
• Accurate definition of normal PSA values is crucial for determining the need for prostate biopsy.
• Previous studies establishing normal PSA values have often lacked diverse representation, particularly of African-American men.

Purpose of the Study:

• To compare serum PSA levels and PSA density between African-American and white men without histologic evidence of prostate cancer.
• To investigate the influence of race on PSA levels and PSA density.
• To assess the applicability of current PSA screening criteria across different racial groups.

Main Methods:

• Retrospective review of medical records of 752 men (white and African-American) who underwent prostate biopsy.
• Analysis included patient age, race, serum PSA level, prostate volume, and biopsy results.
• Multivariate linear regression was used to identify factors associated with serum PSA levels.

Main Results:

• No significant racial differences were observed in age or prostate volume.
• Serum PSA levels and PSA density were significantly higher in African-American men compared to white men (P < .0001).
• Race and prostate volume were independent predictors of serum PSA levels.

Conclusions:

• African-American men without prostate cancer exhibit higher serum PSA levels and PSA density than similarly aged white men.
• Current published criteria for normal PSA levels and density, primarily based on white populations, may not be directly applicable to African-American men.
• Race-specific data are essential for optimizing PSA as a tumor marker, especially in populations at higher risk for prostate cancer mortality.