Racial Differences in Screening for Prostate Cancer in the Elderly

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Abstract
Major racial differences persist in prostate cancer incidence and mortality figures in the United States.1,2 Black men are approximately 60% more likely to be diagnosed as having prostate cancer than white men and twice as likely to die of it. Prostate cancer in black men, compared with white men, has been associated with younger age and more advanced stage and higher grade of disease at the time of diagnosis.3-5 Numerous studies have investigated the patterns and causes of these discrepancies, but the subject remains contentious, particularly as to whether there are racial biological differences that might play a role.6-15 If relevant biological differences exist, they have not been clearly identified, although differences in serum testosterone levels have been reported.16-22 Several studies have reported higher serum testosterone levels in adolescent and young adult black males and in pregnant black women than in whites of the same age and sex.18,20-22 Testosterone is believed to be a key factor in the development of prostate cancer, and if it is true that black men have, on average, higher serum androgen levels, then it is a reasonable hypothesis that that difference could contribute to the higher incidence of prostate cancer seen among black men. However, studies of the relationship between serum androgen levels and prostate cancer have produced conflicting results.23-26