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

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.