Higher Median Prostate-specific Antigen Research Articles

Epidemiology, treatment patterns, and clinical outcomes in de novo oligometastatic hormone-sensitive prostate cancer.

This study was conducted to better characterize the epidemiology, clinical outcomes, and current treatment patterns of de novo oligometastatic hormone-sensitive prostate cancer (omHSPC) in the United States Veterans Affairs Health Care System. In this observational retrospective cohort study, 400 de novo metastatic hormone-sensitive PC (mHSPC) patients diagnosed from January 2015 to December 2020 (follow-up through December 2021) were randomly selected. omHSPC was defined as five or less total metastases (excluding liver) by conventional imaging. Kaplan-Meier methods estimated overall survival (OS) and castration-resistant prostate cancer (CRPC)-free survival from mHSPC diagnosis date and a log-rank test compared these outcomes by oligometastatic status. Twenty percent (79 of 400) of de novo mHSPC patients were oligometastatic. Most baseline characteristics were similar by oligometastatic status; however, men with non-omHSPC had higher median prostate-specific antigen at diagnosis (151.7) than omHSPC (44.1). First-line (1L) novel hormonal therapy was similar between groups (20%); 1L chemotherapy was lower in omHSPC (5%) versus non-omHSPC (14%). More omHSPC patients received metastasis-directed therapy/prostate radiation therapy (14%) versus non-omHSPC (2%). Median OS and CRPC-free survival (in months) were higher in omHSPC versus non-omHSPC (44.4; 95% confidence interval [CI], 33.9-not estimated vs. 26.2; 95% CI, 20.5-32.5, p=.0089 and 27.6; 95% CI, 22.1-37.2 vs. 15.3; 95% CI, 12.8-17.9, p=.0049), respectively. Approximately 20% of de novo mHSPC were oligometastatic, and OS was significantly longer in omHSPC versus non-omHSPC. Although potentially "curative" therapy use was higher in omHSPC versus non-omHSPC, the percentages were still relatively low. Future studies are warranted given potential for prolonged responses with multimodal therapy inclusive of systemic and local therapies.

Treatment and survival of de novo metastatic hormone sensitive prostate cancer among African American US Veterans.

5079 Background: Combinations of androgen deprivation therapy (ADT) plus docetaxel (DOC) or androgen signaling inhibitors (ASIs: abiraterone, enzalutamide, etc.) have revolutionized treatment of metastatic hormone sensitive prostate cancer (mHSPC), particularly for high volume disease. However, little is known about the use of and outcomes of combination therapy in African Americans (AA) with de novo mHSPC, due to their lack of representation in clinical studies. This study evaluates the patient characteristics, treatment, and survival in a cohort of US veterans with mHSPC with equal access to treatment under the Veterans Affairs Health System (VA). Methods: Veterans with mHSPC were identified from 2014-2022 in the VA using the initial pathological diagnosis of prostate cancer with SEER stage ‘distant’ and first ADT initiated within 1 month prior and 3 months after diagnosis. Therapies including DOC or ASIs were collected if initiated from 1 month prior to 4 months after ADT. Additional information at the time of diagnosis was collected including Prostate Specific Antigen (PSA), race from VA enrollment, and Charlson Comorbidity Index (CCI). Median survival was obtained for each group and stratified by PSA level >100 ng/mL. Chi-square and ANOVA testing were used differences in survival (OS) were assessed by log-rank testing. Results: 4,248 veterans with de novo mHSPC were identified, 1138 (26.8%) were AA and 3110 (73.2%) white. Black veterans were younger (70.8 vs. 74.8, p<0.001) and had higher median PSA (183 vs. 86.3, p<0.001) with similar mean CCI (4.4 vs. 4.4, p=0.78). AA veterans were likely to have a PSA >100 ng/mL at diagnosis (61.6% vs. 46.1%, p<0.001) and to receive combination therapy than white veterans (36.8% vs. 32.7%, p=0.01). The median OS among AA and white veterans was similar (32.5 months vs. 32.1, p=0.75). In 2,120 veterans with PSA>100 ng/mL (a surrogate for higher volume disease), AA veterans were more likely to receive combination therapy (39.5% vs. 32.9%, p=0.003) without differences in survival in AA veterans compared to white (31.0 vs. 26.9 months, p=0.18). Conclusions: In an equal access health care system, AA veterans had similar survival to white veterans despite having double the PSA levels, reflecting higher risk disease. AA presented 4 years younger and are likely treated with doublet therapy. The differences in the age of onset and burden of disease highlight persistent differences in populations with mHSPC. Further investigations to understand environmental, social, and tumor factors are warranted to explain these disparities. [Table: see text]

Real-world baseline characteristics and first-line (1L) treatment (Tx) in patients (pts) with de novo metastatic castration-sensitive prostate cancer (mCSPC) by disease volume.

e17081 Background: Intensification of androgen deprivation therapy (ADT) using novel hormonal therapies (NHT) has been established as a new standard of care for pts with mCSPC. Tx intensification still remains suboptimal, and data in de novo mCSPC pts is limited. Moreover, prior studies utilized claims data and so could not assess the impact of disease burden on Tx intensification. This study assessed baseline characteristics and 1L Tx patterns in pts with high-volume (HV) vs low-volume (LV) de novo mCSPC. Methods: This retrospective study used the Veterans Affairs Informatics and Computing Infrastructure to identify adult men who had ≥1 ICD code for prostate cancer and de novo mCSPC diagnosed between February 2018 and June 2020 confirmed by clinical chart review and initiated either ADT alone, ADT + first-generation non-steroidal anti-androgens [NSAA], or ADT+NHT. Index date was defined as ADT initiation date. The volume of disease was defined as HV or LV per the CHAARTED trial criteria (presence of visceral metastasis and/or ≥4 bone metastases, with ≥1 metastasis beyond the pelvis and vertebral column). Clinical data was hand abstracted from the medical record. Baseline characteristics and 1L Tx were analyzed descriptively. Results: Of the 380 de novo mCSPC pts reviewed, 57% had HV and 43% had LV disease. Mean age of pts was similar between HV and LV cohorts, 74.5 vs 75.2 years, respectively. In addition, the proportion of Black vs White pts in the HV and LV cohorts was similar, 34% and 35% were Black, and 66% and 65% were White, respectively. At index date, HV pts had higher median prostate-specific antigen (153.1 ng/mL vs 73.8 ng/mL) and alkaline phosphatase (192.0 IU/L vs 106.0 IU/L) vs LV pts. HV pts were less likely to have diabetes and cardiovascular comorbidities than LV pts (Table); however, the distribution of Charlson Comorbidity Index score was similar between cohorts (mean [SD]: 4.4 [3.1] vs 4.2 [3.1]). Among the pts with bone metastases only, HV pts had higher proportion (65%) of “too numerous to count” bone metastases vs LV pts (9%). While ADT+NHT use was slightly more common among HV pts (35%) vs LV pts (27%), in both HV and LV cohorts, ADT±NSAA was the most common 1L Tx (Table). The median 1L Tx duration was shorter in the HV pts compared with the LV pts (286 vs 358 days). Conclusions: The results showed that Tx intensification was underutilized in de novo mCSPC pts, even among those with HV, pointing toward an unmet need among pts with de novo mCSPC regardless of disease burden. [Table: see text]

Outcomes and factors associated with reclassification in a multiethnic cohort enrolled in active surveillance for prostate cancer.

242 Background: Active surveillance (AS) is the standard of care for low-risk prostate cancer (PCa). However, there is limited data exploring factors associated with reclassification among non-Hispanic Black (NHB) and Hispanic men enrolled in AS. In this study, we examined factors associated with reclassification among men enrolled in AS within a multiethnic population. Methods: We identified men enrolled in AS from 2005-2019 at our institution, and collected demographic/clinical data. We then compared characteristics among men who experienced pathologic reclassification while on AS vs men who did not. Reclassification was defined as either type 1 (Grade Group (GG) 1 to GG2) or type 2 (GG1 to ≥GG3). Our AS protocol generally consists of biannual prostate specific antigen (PSA) testing and prostate biopsy every 1-3 years. Prostate MRI is used to guide decisions on selective basis. Logistic regression was used to determine factors associated with reclassification. Results: Among 197 men enrolled into an AS protocol within our institution, 133 (67.5%) did not experience reclassification by the end of follow-up while 64 (32.5%) did (Table). Median follow-up time was 12 months (IQR: 7-20), and 2-year overall reclassification-free rates were 59.3% (95% CI: 59.2-59.4). 2-year deferred treatment rates were 26.4% (95% CI: 26.3-26.5) for radical prostatectomy (RP) and 16.9% (95% CI: 16.8-17.0) for radiation therapy (RT). NHB and Hispanic men composed 87 (44.2%) and 70 (35.5%) of our cohort, respectively. Higher PSA at diagnosis was associated with adverse reclassification (OR=1.02, 95% CI: 1.01-1.05, p=0.002), and there was a trend towards NHB men having higher odds of experiencing reclassification (OR=2.78, 95% CI: 0.85-9.10) although the result was not statistically significant (p=0.09). Conclusions: In a diverse, multiethnic cohort, rates of adverse reclassification on AS were relatively low. The only factor predictive of reclassification while on AS was higher median PSA at diagnosis; however, NHB men did have a trend towards a higher odds of reclassification. Our results suggest that men who are NHB or have higher PSA at diagnosis may benefit from increased surveillance intensity, as they are more likely to experience reclassification while on AS.[Table: see text]

Multiparametric MRI prostate PI-RAD scoring in a district general hospital: correlating PI-RADS 3 results with histological findings.

Prostate cancer is the most common male cancer in the UK. In many hospitals, patients are now being referred for a multiparametric (mp) MRI scan of their prostate as part of an evaluation for the presence of prostate cancer, prior to an ultrasound-guided biopsy. Prostate Imaging Reporting and Data System (PI-RADS) score of 3 are defined as "equivocal" for the presence of prostate cancer. Thus, a PI-RADS 3 lesion does not confidently determine whether there is significant prostate disease or not.Our aim is to determine the correlation of PI-RADS 3 prostatic lesions with histology proven, clinically significant cancer. We performed a retrospective review on a cohort of 143 consecutive patients. Each patient underwent a mp-MRI scan of their prostate given a PI-RADS score. PI-RADS 3 lesions were analysed further based on histology and categorised into malignant and non-malignant lesions. Prostate-specific antigen (PSA) results and prostatic volume of PI-RADS 3 lesions were also analysed. We identified 45 patients with PI-RADS 3 lesions out of 143 patients. 32 patients subsequently underwent transrectal/transperineal ultrasound-guided biopsy. 43% of patients were found to have had a malignant prostatic adenocarcinoma on histology. The remaining 56% had non-malignant findings. Of those with malignant disease, there was a higher median PSA and lower mean prostatic volume. The study confirms that a score of PI-RADS 3 does not accurately differentiate between malignant and non-malignant lesions. Further investigations such as ultrasound-guided prostate biopsy and PSA parameters are required to accurately ascertain the nature of a prostate lesion with PI-RADS score 3. An ultrasound-guided prostate biopsy in patients with PI-RADS 3 remains of paramount importance when distinguishing malignant vs non-malignant lesions. Multicentre data of MRI findings with PI-RADS 3 scores is required to yield a sample size large enough to carry out statistical analysis.

Racial Disparities in the Presentation, Early Definitive Surgical Treatment, and Mortality Among Men Diagnosed with Poorly Differentiated/Undifferentiated Non-metastatic Prostate Cancer in the USA.

To assess the influence of race on presentation of poorly differentiated/undifferentiated prostate cancer, use of radical prostatectomy (RP) as primary treatment and survival outcomes. Using the 2004-2014 files of the Surveillance, Epidemiology, and End Results (SEER) data, we identified 244,167 black and white men diagnosed with poorly differentiated/undifferentiated prostate cancer. Demographic and tumor characteristics of study patients were compared by race. Logistic regression was used to evaluate the influence of race on receipt of RP. Cox proportional hazard models were fitted to determine the impact of RP and race on cancer-specific mortality (CSM) and all-cause mortality (ACM). Compared to white men, black men were diagnosed of prostate cancer at a younger age (64.2years versus (vs) 67.5years, p < 0.0001) and presented with higher median prostate-specific antigen, PSA (24.4ng/ml vs 22.1ng/ml, p < 0.0001) but lower disease stage. Lower proportion of black men received RP compared to white men (33.9% vs 42.6%; p < 0.0001). The odds of receipt of RP were 2 times higher in white men relative to black men. The risks of CSM and ACM were over 2 times and 3 times respectively higher in patients who did not receive RP vs patients who received RP in the study population and in each race. Despite the younger age at diagnosis of poorly differentiated/undifferentiated prostate cancer and higher PSA at diagnosis in black men, white men had significantly higher odds of receipt of RP relative to black men.

3T multiparametric MR imaging, PIRADSv2-based detection of index prostate cancer lesions in the transition zone and the peripheral zone using whole mount histopathology as reference standard.

To evaluate 3T mpMRI characteristics of transition zone and peripheral zone index prostate cancer lesions stratified by Gleason Score and PI-RADSv2 with whole mount histopathology correlation. An institution review board-approved, HIPAA-compliant single-arm observational study of 425 consecutive men with 3T mpMRI prior to radical prostatectomy from December 2009 to October 2016 was performed. A genitourinary radiologist and a genitourinary pathologist matched all lesions detected on whole mount histopathology with lesions concordant for size and location on 3T mpMRI. Differences in clinical, MRI parameters, and histopathology between transition zone and peripheral zone were determined and analyzed with χ2 and Mann-Whitney U test. AUC was measured. 3T mpMRI detected 248/323 (76.7%) index lesions in peripheral zone and 75/323 (23.2%) in transition zone. Transition zone prostate cancer had higher median prostate-specific antigen (p = 0.001), larger tumor on 3T mpMRI (p = 0.001), lower proportions of PI-RADSv2 category 4 and 5 (p < 0.001), and lower pathological stage (p = 0.055) compared to peripheral zone prostate cancer. No significant differences were detected in prostate-specific antigen density, preoperative biopsy, and pathology Gleason Scores. After adjusting for significant variables from univariate analysis including prostate volume, tumor volume, prostate-specific antigen, PI-RADSv2 category, AUC for predicting clinically significant tumor in transition zone and peripheral zone were 0.80 and 0.72, respectively (p = 0.36). The diagnostic performance of PI-RADSv2 for clinically significant transition and peripheral zone prostate cancer was similar. However, there was a lower portion of PI-RADSv2 4 and 5 lesions in transition zone compared to peripheral zone.

PD40-03 EFFECT OF 5-ALFA REDUCTASE INHIBITOR USAGE ON OUTCOMES OF PROSTATE CANCER SCREENING

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2017PD40-03 EFFECT OF 5-ALFA REDUCTASE INHIBITOR USAGE ON OUTCOMES OF PROSTATE CANCER SCREENING Teemu Murtola, Anniina Virkku, Kirsi Talala, Ulf-Håkan Stenman, Kimmo Taari, Teuvo Tammela, and Anssi Auvinen Teemu MurtolaTeemu Murtola More articles by this author , Anniina VirkkuAnniina Virkku More articles by this author , Kirsi TalalaKirsi Talala More articles by this author , Ulf-Håkan StenmanUlf-Håkan Stenman More articles by this author , Kimmo TaariKimmo Taari More articles by this author , Teuvo TammelaTeuvo Tammela More articles by this author , and Anssi AuvinenAnssi Auvinen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (PCa) screening with prostate-specific antigen (PSA) reduces PCa mortality, but leads to overdiagnosis of indolent PCa. Use of 5-alpha reductase inhibitors (5-ARIs) lowers PSA and in theory could affect performance of PSA-based screening. We evaluated outcomes of PCa screening among 5-ARI users. METHODS The study was performed within the Finnish Randomized Study of Screening for Prostate Cancer. Of 80,454 men, 31,866 were randomized to be screened at four-year intervals during 1996-2004. Information on 5-ARI reimbursements before PCa during 1995-2009 was collected from the national prescription database for 78,615 men. We evaluated the effect of screening on PCa risk and mortality by 5-ARI usage using Cox regression. RESULTS Men using 5-ARIs had higher median PSA and were more often screen-positive compared to non-users. Despite this, screening did not significantly affect PCa detection (HR 0.89, 95% CI 0.79-1.01) or mortality (HR 0.82, 95% CI 0.51-1.32) compared to the control arm among 5-ARI users. In ROC analysis, PSA and age did not predict Gleason 7-10 prostate cancer as accurately in 5-ARI users as among the non-users (AUC = 0.88 versus 0.79 in the first screening round). CONCLUSIONS PSA-based screening among men using 5-ARIs does not improve detection of high-grade or metastatic PCa or prevention of PCa deaths. Targeted screening should focus on men not using 5-ARIs. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e751 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Teemu Murtola More articles by this author Anniina Virkku More articles by this author Kirsi Talala More articles by this author Ulf-Håkan Stenman More articles by this author Kimmo Taari More articles by this author Teuvo Tammela More articles by this author Anssi Auvinen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes of Prostate Cancer Screening by 5α-Reductase Inhibitor Use

Prostate cancer screening with prostate specific antigen reduces prostate cancer mortality but leads to over diagnosis of indolent prostate cancer. The use of 5α-reductase inhibitors lowers prostate specific antigen and in theory could affect the performance of prostate specific antigen based screening. We evaluated the outcomes of prostate cancer screening in 5α-reductase inhibitors users. The study was performed in FinRSPC (Finnish Randomized Study of Screening for Prostate Cancer). Of 80,454 men 31,866 were randomized to be screened at 4-year intervals during 1996 to 2004. Information on 5α-reductase inhibitors reimbursements before prostate cancer during 1995 to 2009 was collected from the national prescription database for 78,615 men. We evaluated the effect of screening on prostate cancer risk and mortality by 5α-reductase inhibitors using Cox regression. Men receiving 5α-reductase inhibitors had higher median prostate specific antigen and were more often screen positive than nonusers. Despite this, screening did not significantly affect prostate cancer detection (HR 0.89, 95% CI 0.79-1.01) or mortality (HR 0.82, 95% CI 0.51-1.32) compared to findings in the control arm among men on 5α-reductase inhibitors. On ROC analysis prostate specific antigen and age did not predict Gleason 7-10 prostate cancer as accurately in 5α-reductase inhibitors users as it did among nonusers (first screening round AUC 0.79 vs 0.88). Prostate specific antigen based screening among men receiving 5α-reductase inhibitors did not improve the detection of high grade or metastatic prostate cancer, or prevent prostate cancer death.

Impact of race on survival in patients with clinically nonmetastatic prostate cancer who deferred primary treatment.

Prostate cancer (PCa) racial disparity studies typically focus on survival differences after curative treatment. The authors of this report hypothesized that comparing mortality rates between African American (AA) and Caucasian American (CA) patients who deferred primary treatment for clinically nonmetastatic PCa may provide a better assessment of the impact of race on the natural course of PCa. The pathology database of the New York Veterans Administration Medical Center (VAMC), an equal access-of-care facility, was searched for patients with biopsy-proven PCa. Inclusion criteria included 1) no evidence of metastatic disease or death within 3 years after diagnosis, 2) no primary treatment, and 3) a minimum of 5 years of follow-up for survivors. In total, 518 patients met inclusion criteria between 1990 and 2005. AA patients were younger (P = .02) and had higher median prostate-specific antigen (PSA) levels (P = .001) at the time of diagnosis compared with CA patients. In a multivariate model, higher Gleason score and PSA level were associated with increased mortality (P = .001 and P = .03, respectively), but race was not a predictor of death from PCa. The current data suggested that race did not have a major impact on survival in patients with PCa who deferred primary treatment for clinically nonmetastatic disease.

Poxviral-Based Prostate-Specific Antigen Vaccine in Prostate Cancer

TO THE EDITOR: In the March 1, 2010, issue of Journal of Clinical Oncology, Kantoff et al reported the results of a phase II randomized trial of a poxviral-based prostate-specific antigen vaccine (PROSTVAC) in metastatic castration-resistant prostate cancer. Eighty-two patients received PROSTVAC and 40 received control vectors. The primary end point was progression-free survival, which was similar in both groups (hazard ratio, 0.884; 95% CI, 0.568 to 1.375; P .6), but overall survival (OS) favored PROSTVAC arm (25.1 v 16.6 months). The authors conclude that PROSTVAC immunotherapy is associated with a 44% reduction in the death rate and an 8.5-month improvement in median OS. Although these data merit further exploration, we have concerns about whether both study arms are comparable. First, the difference in median age (71.6 v 79 years), percentage of lymph node involvement only (9.8% v 0%), and median survival estimated by Halabi nomogram may favor the PROSTVAC arm. Second, as Kantoff et al point out, the lack of treatment data after initial progression limits the interpretation of the survival result. PROSTVAC plus subsequent treatment improved in 3 months the survival predicted by Halabi. In the control arm, OS is reduced by 4 months as estimated by the Halabi nomogram. Half of the patients in the control arm received PROSTVAC as second-line treatment. An interesting question is whether a higher percentage of patients in the PROSTVAC arm received second-line docetaxel, obtaining a benefit in survival. Third, Kantoff et al mentioned that only docetaxel has been shown to affect survival in metastatic prostate cancer, by approximately 3 months. In the TAX 327 study, an OS of 19.2 months was reported in the every-3-weeks docetaxel arm. Nevertheless, patients included in the TAX 327 had an disfavorable prognosis when compared with the PROSTVAC study. Patients in TAX 327 were more symptomatic with a higher median prostate-specific antigen, Eastern Cooperative Oncology Group performance status of 2 was permitted, and 30% of patients had a Gleason score of 8 to 10. In a retrospective subanalysis of 110 minimally symptomatic patients, Berthold et al reported an OS of 28.4, 25.9, and 22 months for docetaxel every 3 weeks, docetaxel every week, or mitoxantrone, respectively. These differences did not reach statistical significance as a result of the small number of patients, and the results should be interpreted with caution. These data suggest than docetaxel should offer similar results to PROSTVAC in this population and should be the control arm in a phase III study. We agree with Kantoff et al that their findings are regarded as hypothesis generating, but OS data should be interpreted with caution in the absence of treatment information after progression to PROSTVAC or placebo.

The Impact of Obesity on the Diagnosis of Prostate Cancer Using a Modern Extended Biopsy Scheme

The effect of obesity on prostate cancer detection and behavior remains uncertain. We evaluated the impact of obesity, as measured by body mass index, in a case series of 500 consecutive men who underwent a modern 10 to 12 core biopsy approach. We retrospectively reviewed the records of a consecutive series of 500 men who underwent transrectal ultrasound guided prostate biopsy using a 10 to 12 core biopsy scheme. Variables, including patient age, prostate specific antigen, prostate specific antigen density, digital rectal examination findings, transrectal ultrasound prostate volume and biopsy outcome, including grade, were compared to anthropometric measures, including body mass index. Of the men 26% were obese according to body mass index (greater than 30 kg/m(2)). A total of 223 men (45%) had a positive biopsy. Obese men were younger (62.0 vs 63.8 years), had a larger prostate (57.7 vs 47.8 cc) and were less likely to have any abnormality on digital rectal examination (19.6% vs 30.8%). Obese men were also less likely to have a positive biopsy based on chi-square analysis (38.8% vs 46.2%). On statistical modeling for the OR in nonobese vs obese men there was a trend toward lower detection based on crude and age adjusted ORs but not on multivariate OR controlling for age, prostate specific antigen and prostate volume. In addition, when examining for high grade disease (Gleason 4 + 3 or greater), no differences were observed on OR modeling. In men with negative biopsies those who were obese vs nonobese had a larger prostate volume and trended toward a higher median prostate specific antigen and age. These differences and trends were not observed in obese men with positive biopsies. Of men undergoing prostate biopsy using a modern extended biopsy scheme obese men were younger, had a larger prostate and were less likely to have abnormal digital rectal examinations. Although some trends toward a lower detection rate in obese men were observed, such differences were not observed on multivariate analysis, nor were any differences observed in the incidence of higher grade tumors, thus questioning the effect of obesity on prostate cancer detection and behavior in our cases series.

The impact of race on biochemical disease-free survival in early-stage prostate cancer patients treated with surgery or radiation therapy

Purpose: To assess the impact of race on biochemical freedom from recurrence in patients with early-stage prostate cancer treated either by radical prostatectomy or radiation therapy. Methods: Between July 1989 and December 1994, 693 patients with early-stage prostate cancer were treated with radiation (302 patients) or by radical prostatectomy (391 patients) at Barbara Ann Karmanos Cancer Institute/Wayne State University. Stage, Gleason score, race, pretreatment PSA, and follow-up PSA values were abstracted. There were 387 Caucasian males (CM) and 306 African-American males (AAM). None of the patients received hormone therapy. Radiation therapy was delivered using photon irradiation (249 patients, median dose 69 Gy) or mixed neutron/photon irradiation (53 patients, median dose 10 NGy + 38 PGy). Median follow-up was 36 months (range 2–70) for CM and 35 months (range 1–70) for AAM. Results: Thirty-seven percent of patients treated surgically were AAM, compared to 53% in the radiation group ( p = 0.0001). AAM had a higher median prostate-specific antigen (PSA) than CM (9.78 ng/ml vs. 8.0 ng/ml, p = 0.01). Thirty-three percent of AAM had a pretreatment PSA greater than 15 ng/ml compared to 20% of CM ( p = 0.00001). Disease-free survival (DFS) by race was equivalent at 36 months, 81% for CM and 77% for AAM ( p = NS). For patients with PSA ≤ 15, DFS rates were 87% and 85% for CM and AAM, respectively. DFS rates for patients with PSA > 15 were 61% for CM and 64% for AAM ( p = NS). Significant prognostic factors on multivariate analysis included pretreatment PSA ( p = 0.0001) and Gleason score ( p = 0.0001). Conclusion: Race does not appear to adversely affect biochemical disease-free survival in males treated for early-stage prostate cancer. African-American males with early-stage prostate cancer should expect similar biochemical disease-free survival rates to those seen in Caucasian males.