Black Race Predicts Significant Prostate Cancer Independent of Clinical Setting, and Clinical and Socioeconomic Risk Factors: evidence for a biological basis of disparities

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Several studies have linked Black race to prostate cancer (PCa) risk but most fail to account for established clinical factors such as 5-alpha reductase inhibitor (5-ARI) use and prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains strongly associated with PCa and Gleason ≥3+4 PCa, after adjusting for clinical setting, socioeconomic and clinical factors at prostate biopsy.


We recruited 564 men over age 40 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Information was retrieved from self-administered surveys and electronic health records. Univariate and multivariate analyses examined the associations between hospital type, race, clinical and sociodemographic risk factors with PCa diagnosis and Gleason ≥3+4 PCa. Given changes in PCa screening recommendations, we also performed multivariate analyses for men ages 40 to 54.


Black and White men had similar age, BMI and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL, p 3 vs. 0.15 ng/mL/cm3, p


Black race is independently associated with PCa and Gleason ≥3+4 PCa after accounting for clinical and socioeconomic risk factors including clinical setting and is the strongest PCa risk factor in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.

Funding: 1R01MD007105-01 (Kittles) IK2CX000926-01 (Murphy) W81XWH-10-1-0532 pd22E (Murphy) P50CA090386 (Catalona)