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. 2006 Apr;98(4):515–519.

Prostate cancer screening and detection in inner-city and underserved men.

Satoshi Anai 1, John Pendleton 1, Peter Wludyka 1, Christopher Williams 1, Leah Nelms 1, Curtis Pettaway 1, Charles J Rosser 1
PMCID: PMC2569232  PMID: 16623063

Abstract

CONTEXT: In the era of serum prostate-specific antigen (PSA) screening, the incidence of prostate cancer has increased dramatically. Simultaneously however, stage migration has occurred, and treatment outcomes have improved. Inner-city men have lower screening rates and, thus, may be diagnosed with more advanced disease that it less likely to be successfully treated. OBJECTIVE: To assess the detection rate of prostate cancer and tumor stage at presentation in inner-city men. DESIGN, SETTING, AND PATIENTS: A retrospective cohort of 368 men underwent transrectal ultrasound needle-guided biopsy at an inner-city hospital from January 2003 to May 2005. Clinical and pathologic data were collected and analyzed. MAIN OUTCOME MEASURES: Clinic and hospital records were reviewed for several key outcomes, including prostate cancer incidence, tumor stage and tumor grade. RESULTS: The median age of the cohort was 67 +/- 9.1 years (range, 23-93 years). Prostate cancer was diagnosed in 44% of subjects (161/368). The median PSA level at the time of diagnosis was significantly higher in African-American men than in Caucasian men (9.82 vs. 5.97 ng/mL, P=0.008). Abnormally high serum PSA levels (>20 ng/mL) were present in disproportionately more African-American men than Caucasian men with prostate cancer (32.9% vs. 19.7% P=0.011). African-American men in this inner-city cohort also had a higher incidence of advanced disease or distant metastasis (T3/T4, N1, or M1) than did Caucasians (16.1% vs. 3.8%; P=0.045). CONCLUSIONS: Compared with inner-city Caucasian men, disproportionately more inner-city, African-American men present with advanced prostate cancer. This observation warrants prostate cancer education and consideration of early detection programs in underserved inner-city communities.

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Selected References

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  1. Bartsch G., Horninger W., Klocker H., Reissigl A., Oberaigner W., Schönitzer D., Severi G., Robertson C., Boyle P., Tyrol Prostate Cancer Screening Group Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria. Urology. 2001 Sep;58(3):417–424. doi: 10.1016/s0090-4295(01)01264-x. [DOI] [PubMed] [Google Scholar]
  2. Benson M. C., Whang I. S., Pantuck A., Ring K., Kaplan S. A., Olsson C. A., Cooner W. H. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol. 1992 Mar;147(3 Pt 2):815–816. doi: 10.1016/s0022-5347(17)37393-7. [DOI] [PubMed] [Google Scholar]
  3. Berger Andreas P., Gozzi Christian, Steiner Hannes, Frauscher Ferdinand, Varkarakis John, Rogatsch Hermann, Bartsch Georg, Horninger Wolfgang. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. 2004 Apr;171(4):1478–1481. doi: 10.1097/01.ju.0000116449.01186.f7. [DOI] [PubMed] [Google Scholar]
  4. Bill-Axelson Anna, Holmberg Lars, Ruutu Mirja, Häggman Michael, Andersson Swen-Olof, Bratell Stefan, Spångberg Anders, Busch Christer, Nordling Stig, Garmo Hans. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005 May 12;352(19):1977–1984. doi: 10.1056/NEJMoa043739. [DOI] [PubMed] [Google Scholar]
  5. Boehm S., Coleman-Burns P., Schlenk E. A., Funnell M. M., Parzuchowski J., Powell I. J. Prostate cancer in African American men: increasing knowledge and self-efficacy. J Community Health Nurs. 1995;12(3):161–169. doi: 10.1207/s15327655jchn1203_4. [DOI] [PubMed] [Google Scholar]
  6. Eastham J. A., Kattan M. W. Disease recurrence in black and white men undergoing radical prostatectomy for clinical stage T1-T2 prostate cancer. J Urol. 2000 Jan;163(1):143–145. [PubMed] [Google Scholar]
  7. Freedland S. J., Sutter M. E., Naitoh J., Dorey F., Csathy G. S., Aronson W. J. Clinical characteristics in black and white men with prostate cancer in an equal access medical center. Urology. 2000 Mar;55(3):387–390. doi: 10.1016/s0090-4295(99)00461-6. [DOI] [PubMed] [Google Scholar]
  8. Gelfand D. E., Parzuchowski J., Cort M., Powell I. Digital rectal examinations and prostate cancer screening: attitudes of African American men. Oncol Nurs Forum. 1995 Sep;22(8):1253–1255. [PubMed] [Google Scholar]
  9. Hoffman R. M., Gilliland F. D., Eley J. W., Harlan L. C., Stephenson R. A., Stanford J. L., Albertson P. C., Hamilton A. S., Hunt W. C., Potosky A. L. Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 2001 Mar 7;93(5):388–395. doi: 10.1093/jnci/93.5.388. [DOI] [PubMed] [Google Scholar]
  10. Iselin C. E., Box J. W., Vollmer R. T., Layfield L. J., Robertson J. E., Paulson D. F. Surgical control of clinically localized prostate carcinoma is equivalent in African-American and white males. Cancer. 1998 Dec 1;83(11):2353–2360. doi: 10.1002/(sici)1097-0142(19981201)83:11<2353::aid-cncr15>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  11. Jani A. B., Vaida F., Hanks G., Asbell S., Sartor O., Moul J. W., Roach M., 3rd, Brachman D., Kalokhe U., Muller-Runkel R. Changing face and different countenances of prostate cancer: racial and geographic differences in prostate-specific antigen (PSA), stage, and grade trends in the PSA era. Int J Cancer. 2001 Dec 20;96(6):363–371. doi: 10.1002/ijc.1035. [DOI] [PubMed] [Google Scholar]
  12. Jemal Ahmedin, Murray Taylor, Ward Elizabeth, Samuels Alicia, Tiwari Ram C., Ghafoor Asma, Feuer Eric J., Thun Michael J. Cancer statistics, 2005. CA Cancer J Clin. 2005 Jan-Feb;55(1):10–30. doi: 10.3322/canjclin.55.1.10. [DOI] [PubMed] [Google Scholar]
  13. Johnstone Peter A. S., Kane Christopher J., Sun Leon, Wu Hongyu, Moul Judd W., McLeod David G., Martin Douglas D., Kusuda Leo, Lance Raymond, Douglas Robert. 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. 2002 Nov;225(2):420–426. doi: 10.1148/radiol.2252011491. [DOI] [PubMed] [Google Scholar]
  14. Naughton C. K., Miller D. C., Mager D. E., Ornstein D. K., Catalona W. J. A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol. 2000 Aug;164(2):388–392. [PubMed] [Google Scholar]
  15. Powell I. J., Heilbrun L., Littrup P. L., Franklin A., Parzuchowski J., Gelfand D., Sakr W. Outcome of African American men screened for prostate cancer: the Detroit Education and Early Detection Study. J Urol. 1997 Jul;158(1):146–149. doi: 10.1097/00005392-199707000-00045. [DOI] [PubMed] [Google Scholar]
  16. Price J. H., Colvin T. L., Smith D. Prostate cancer: perceptions of African-American males. J Natl Med Assoc. 1993 Dec;85(12):941–947. [PMC free article] [PubMed] [Google Scholar]
  17. Roach M., 3rd, Lu J., Pilepich M. V., Asbell S. O., Mohiuddin M., Terry R., Grignon D. Long-term survival after radiotherapy alone: radiation therapy oncology group prostate cancer trials. J Urol. 1999 Mar;161(3):864–868. doi: 10.1016/s0022-5347(01)61793-2. [DOI] [PubMed] [Google Scholar]
  18. Roach Mack, 3rd, Lu Jiandong, Pilepich Miljenko V., Asbell Sucha O., Mohiuddin Mohammed, Grignon David. Race and survival of men treated for prostate cancer on radiation therapy oncology group phase III randomized trials. J Urol. 2003 Jan;169(1):245–250. doi: 10.1016/S0022-5347(05)64078-5. [DOI] [PubMed] [Google Scholar]
  19. Roberts R. O., Bergstralh E. J., Katusic S. K., Lieber M. M., Jacobsen S. J. Decline in prostate cancer mortality from 1980 to 1997, and an update on incidence trends in Olmsted County, Minnesota. J Urol. 1999 Feb;161(2):529–533. [PubMed] [Google Scholar]
  20. Robinson S. B., Ashley M., Haynes M. A. Attitudes of African Americans regarding screening for prostate cancer. J Natl Med Assoc. 1996 Apr;88(4):241–246. [PMC free article] [PubMed] [Google Scholar]
  21. Rosser Charles J., Kuban Deborah A., Lee Sang-Joon, Levy Lawrence B., Pettaway Curtis, Kamat Ashish M., Chichakli Ramsey, Lee Andrew, Cheung Rex M., Sanchez-Ortiz Ricardo. Racial influence on biochemical disease-free survival in men treated with external-beam radiotherapy for localized prostate cancer. J Natl Med Assoc. 2004 Jul;96(7):939–944. [PMC free article] [PubMed] [Google Scholar]
  22. Shaw M., Elterman L., Rubenstein M., McKiel C. F., Guinan P. Changes in radical prostatectomy and radiation therapy rates for African Americans and whites. J Natl Med Assoc. 2000 Jun;92(6):281–284. [PMC free article] [PubMed] [Google Scholar]
  23. Stamey Thomas A., Caldwell Mitchell, McNeal John E., Nolley Rosalie, Hemenez Marci, Downs Joshua. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol. 2004 Oct;172(4 Pt 1):1297–1301. doi: 10.1097/01.ju.0000139993.51181.5d. [DOI] [PubMed] [Google Scholar]
  24. Stamey Thomas A., Caldwell Mitchell, McNeal John E., Nolley Rosalie, Hemenez Marci, Downs Joshua. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol. 2004 Oct;172(4 Pt 1):1297–1301. doi: 10.1097/01.ju.0000139993.51181.5d. [DOI] [PubMed] [Google Scholar]
  25. Stephenson R. A., Stanford J. L. Population-based prostate cancer trends in the United States: patterns of change in the era of prostate-specific antigen. World J Urol. 1997;15(6):331–335. doi: 10.1007/BF01300179. [DOI] [PubMed] [Google Scholar]
  26. Vijayakumar S., Winter K., Sause W., Gallagher M. J., Michalski J., Roach M., Porter A., Bondy M. Prostate-specific antigen levels are higher in African-American than in white patients in a multicenter registration study: results of RTOG 94-12. Int J Radiat Oncol Biol Phys. 1998 Jan 1;40(1):17–25. doi: 10.1016/s0360-3016(97)00834-1. [DOI] [PubMed] [Google Scholar]
  27. Winkler M. H., Gillatt D. A. Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period. Prostate Cancer Prostatic Dis. 2004;7(3):258–262. doi: 10.1038/sj.pcan.4500734. [DOI] [PubMed] [Google Scholar]
  28. Zagars G. K., Pollack A., Pettaway C. A. Prostate cancer in African-American men: outcome following radiation therapy with or without adjuvant androgen ablation. Int J Radiat Oncol Biol Phys. 1998 Oct 1;42(3):517–523. doi: 10.1016/s0360-3016(98)00260-0. [DOI] [PubMed] [Google Scholar]

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