Age and Racial Differences Among PSA-Detected (AJCC Stage T1cN0M0) Prostate Cancer in the U.S.: A Population-Based Study of 70,345 Men

Abstract

Purpose: Few studies have evaluated the risk profile of PSA-detected T1cN0M0 prostate cancer, defined as tumors diagnosed by needle biopsy because of elevated PSA levels without other clinical signs of disease. However, some men with stage T1cN0M0 prostate cancer may have high-risk disease, thus experiencing inferior outcomes as predicted by a risk group stratification model.Methods: We identified men diagnosed with stage T1cN0M0 prostate cancer from 2004-2008 reported to the SEER program. Multivariate logistic regression was used to model the probability of intermediate-risk (PSA >10 ng/ml but < 20 ng/ml and/or GS 7), and high-risk disease (PSA >20 ng/ml, and/or GS ≥8), relative to low-risk disease (PSA <10 ng/ml and GS ≤6), adjusting for age, race, marital status, median household income, and area of residence. Results: A total of 70,345 men with PSA-detected T1cN0M0 prostate cancer were identified. Of these, 47.6%, 35.9%, and 16.5% presented with low-, intermediate-, and high-risk disease, respectively. At baseline (50 years of age), risk was higher for black men than for whites for high-risk disease (OR 3.31, 95% CI 2.85-3.84). The ORs for age (per year) for high-risk disease relative to low-risk disease were 1.09 (95% CI 1.09-1.10) for white men, and as 1.06 (95% CI 1.05-1.07) for black men. Further, among a subgroup of men with low PSA (<10 ng/ml) T1cN0M0 prostate cancer, risk was also higher for black man than for white men at baseline (50 years of age) (OR 2.70, 95% CI 2.09-3.48). The ORs for age (per year) for high-risk disease relative to low-risk disease were 1.09 (95% CI 1.09-1.10) for white men, and as 1.06 (95% CI 1.05-1.07) for black men.Conclusions: A substantial proportion of men with PSA-detected prostate cancer as reported to the SEER program had high-risk disease. Black race and older age were associated with a greater likelihood of high-risk disease