Elsevier

Urology

Volume 67, Issue 1, January 2006, Pages 120-124
Urology

Adult urology
Differences in clinicopathologic features of prostate cancer between black and white patients treated in the 1990s and 2000s

https://doi.org/10.1016/j.urology.2005.08.005Get rights and content

Abstract

Objectives

We have previously reported on the disparity in the clinicopathologic features of prostate cancer between black and white patients at our equal-access institution during the 1990s. The goal of this study was to determine whether the worse clinicopathologic features of prostate cancer in black patients have persisted in the 2000s.

Methods

We examined 362 men (224 black and 138 white) treated with radical prostatectomy at the Veterans Affairs Medical Center in New York. We compared the clinicopathologic variables between 227 patients treated during the 1990s (group 1) and 135 treated in the 2000s (group 2).

Results

In group 1, black patients were significantly younger (P <0.001) and had a greater prostate-specific antigen (PSA) level (P = 0.001), Gleason score (P = 0.005), and stage (P = 0.03) than white patients. In group 2, black patients continued to have significantly greater PSA levels (P = 0.04) and Gleason scores (P = 0.005) than white patients. Comparing only the black patients, those in group 2 had significantly lower PSA levels (P <0.001) and stage (P = 0.03), but had worse Gleason scores (P = 0.03) than those in group 1. On multivariate analysis, black patients were significantly more likely to have a worse Gleason score (P = 0.005) than white patients.

Conclusions

Our data have demonstrated a narrowing of the differences in pathologic stage between black and white patients in the 2000s. However, black men have continued to have worse Gleason scores and greater PSA levels than white patients. These findings suggest that there may be different patterns of molecular alterations in black men that may contribute to the poor tumor differentiation. Additional research is underway to better characterize these underlying molecular mechanisms.

Section snippets

Material and methods

The data from 362 consecutive patients undergoing RP at the Veterans Affairs New York Harbor Healthcare System were compiled and analyzed after the institutional review board approved the study. Patients who received neoadjuvant hormonal and/or radiotherapy were not included in the database. We compared the 227 patients in group 1, who had undergone surgery in the 1990s, with the 135 patients in group 2, who were treated from 2000 to 2004.

The patients self-identified themselves as black (n =

Results

Table I shows a comparison of the differences in the clinicopathologic variables between groups 1 and 2. The data in Table I demonstrate the worse clinicopathologic features of CaP in black patients who underwent RP in the 1990s (group 1) compared with the white patients treated during the same period. The black patients in group 1 were significantly younger and had a greater pretreatment PSA level, Gleason score, and pathologic stage than did the white patients. In group 2, the black patients

Comment

In this study, we examined the changes in the disparity of the clinicopathologic features of CaP between black and white patients at our equal-access institution between the 1990s and 2000s. Our results have demonstrated several important points. First, we observed a narrowing of the difference in the pathologic stage over time between the black and white patients, likely due to the significant stage migration at presentation among the black patients. Second, the previously observed disparity

Conclusions

We have shown that between the 1990s and 2000s, the disparity in pathologic stage and age at RP has diminished between black and white patients treated at the Veterans Affairs Medical Center in New York. Significant differences, however, remained in the pretreatment PSA level and Gleason score, suggesting that early screening is especially important for black patients. Additional follow-up and research are necessary to determine whether these findings are associated with greater rates of

Cited by (0)

This study was supported by Department of Defense DOD (PC040021 to I. Osman); and in part by the use of facilities at the Manhattan Veterans Affairs Medical Center, New York, New York.

View full text