African Americans (AAs) with prostate cancer who have a Gleason score of 3+3=6 produce less prostate-specific antigen (PSA) than Caucasian patients with prostate cancer, according to a study published in The Journal of Urology.1

Additionally, while AAs may have serum PSA levels and PSA mass equal to that of Caucasians, they have significantly larger prostates with all other parameters being the same.

Researchers led by Oleksandr Kryvenko, MD, of the University of Miami Miller School of Medicine in Miami, FL, measured tumor volume in 414 consecutive radical prostatectomies from 348 Caucasian and 66 AAs who had National Comprehensive Cancer Network (NCCN) low-risk prostate cancer and Gleason score of 3+3=6 upon surgery.

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They compared clinical presentation, pathologic findings, PSA, PSA density, as well as mass between the two groups.

While AAs and Caucasians were found to have similar clinical findings in age, body mass index, and PSA, as well as no statistically significant difference between dominant tumor nodule and total tumor volumes, prostates were found to be heavier in AAs.

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Despite larger benign prostate tissue weight that contributed to PSA in AAs, PSA mass was not different from Caucasians, and PSA density was found to be significantly less in AAs due to larger prostates.

“This has practical implications in T1c patients diagnosed with prostate cancer due to PSA screening,” the authors concluded. “Lowering PSA density threshold in AA men may account for this disparity, particularly in selecting patients for active surveillance program.”


  1. Kryvenko ON, Balise R, Prakash NS, et al. African American men with Gleason Score 3+3=6 prostate cancer produce less PSA than Caucasian men: a potential impact on active surveillance. [published online ahead of print September 1, 2015]. J Urol. doi: 10.1016/j.juro.2015.08.089.