The goal of this study was to evaluate whether there are racial differences in stage of diagnosis of prostate cancer. This study is unique in that it was conducted in a Veteran Administration Medical Center, which is considered an equal access delivery system and it identified patients who were diagnosed with prostate cancer after prostate-specific antigen testing entered widespread use for early detection of prostate cancer. Subjects were black and white patients of VAMC urology clinics in the Los Angeles and adjacent areas who were diagnosed between 1991 and 1997.

Most study subjects were between 60 and 69 years of age (52% of blacks and 48% of whites). The vast majority of patients were diagnosed at local stages (87% of black patients and 88% of white patients). However, the tumor grades were higher for black patients on average compared with white patients (Gleason score = 6.2 for blacks versus 5.9 for whites). A larger proportion of black patients had poorly differentiated tumors (45% of blacks versus 38% of whites). Additionally, a larger proportion of blacks had high serum PSA levels compared with whites (36% versus 22%). It will be important to follow patients for outcome data to determine if these two racial patterns are indeed clinically significant findings.

While this study did not report differences in stage, differences in disease were noted. It is possible that the availability of the PSA screening test has reduced the race differences in stage at diagnosis, but it is still possible that race differences persist. In any case, it is crucial to follow these patients, who did not show differences in stage at presentation, to determine if the commonly racial disparities in mortality from prostate cancer persist.