Prostate cancer detection in high-risk men.

B6

Purpose: Prostate cancer is now the most common cancer in men in the United States. Men with a family history of prostate cancer and African American men are at higher than average risk for developing the disease. The predictive value of various screening parameters for high-risk men has not been firmly established. The Fox Chase Cancer Center (FCCC) Prostate Cancer Risk Assessment Program (PRAP) was established in 1996 with a primary goal of providing prostate cancer screening and risk assessment for men at high risk for prostate cancer. This analysis was performed to determine the positive predictive value (PPV) of four screening parameters for detecting prostate cancer and comparing the results between African American (AA) and non-AA men. Methods: Participants for PRAP are accrued by radio advertisements, community health fairs, and physician referrals. Eligibility criteria include any man between the ages of 34-69 years with (1) one or more first-degree relatives with prostate cancer or (2) two second-degree relatives (on the same side of the family) with prostate cancer or (3) any African American man regardless of family history of prostate cancer. The screening parameters analyzed for their PPV were abnormal DRE, PSA>4.0 ng/mL, PSA 2.0-4.0 ng/mL AND percent free PSA <27%, and PSA velocity of 0.75ng/mL/year. The PPV of these measures was defined as among all men who had a positive screening parameter, the proportion of men who had a biopsy positive for cancer. Standard statistical techniques were used for this analysis using two-by-two tables and univariate analysis. The statistical software was SAS v. 8.2. Results: 610 men participate in PRAP, and fifty-six have a diagnosis of prostate cancer. The cumulative incidence of prostate cancer is 9.2%. The mean age at diagnosis is 56.4 +/- 7.89 years. The mean baseline PSA for the entire cohort is 1.62 ng/mL and the median baseline PSA is 0.9 ng/mL. The mean percent free PSA for the group is 16.9% with a median of 16%. Five-hundred forty six men (89.5%) have had digital rectal examinations performed. Twenty participants (3.3%) have had a PSA velocity of 0.75ng/mL/year. A PSA 2.0-4.0 AND percent free PSA <27% proved to have a higher PPV for AA men than for non-AA men (44.9% vs. 34.5%, respectively). In addition, the PPV of a PSA velocity of 0.75ng/mL/year was higher for AA men that non-AA men as well (41.7% vs. 12.5%, respectively). Conclusion: The PPV of the PSA velocity and the combination of PSA 2.0-4.0 ng/mL with a percent free PSA <27% is higher for AA men for having prostate cancer on prostate biopsy in this cohort.