The impact of African American race on prostate cancer detection on repeat prostate biopsy in a veteran population.

Abstract

Racial differences in the incidence of prostate cancer on initial biopsy are well established, but the predictive value of African American race on the probability of prostate cancer detection on repeat biopsy is unknown. At a single institution between January 2007 and June 2014, we reviewed 277 men who first underwent a negative transrectal ultrasound guided needle biopsy of the prostate, and who then subsequently underwent a second biopsy. Detection rates were compared via Chi-square analysis. Race, age, PSA, presence of high-grade prostatic intraepithelial neoplasia, presence of atypical small acinar proliferation, prostate volume, PSA velocity and PSA density were compared via a multivariate logistic regression analysis. 496 AA men and 352 Caucasian men underwent initial biopsy, and AA men had a 49% cancer detection rate, compared to 34% in Caucasians (p<0.0001). AA men also had a greater incidence of Gleason 7 cancers (p=0.00018) and a smaller mean TRUS volume (p=0.006) compared to Caucasians. On repeat biopsy, AA men no longer had a higher cancer detection rate (p=0.227), nor difference in Gleason 7 detection or TRUS volume (p=0.0992). On initial biopsy, AA race and increasing PSA were both associated with an increased likelihood for cancer detection (p<0.001 for both). After an initial negative biopsy, AA race no longer predicted for future malignancy detection (p=0.57), nor did PSA (p=0.36). In a cohort of men with high pre-test probability of prostate cancer and an initial negative biopsy, African American race in a veteran population fails to predict the detection of future prostate cancer.