荧光支气管镜与白光支气管镜对肺癌诊断价值的 Meta 分析

目的：比较荧光支气管镜（autofluorescence bronchoscope，AFB）与普通光支气管镜（white light bron-choscope，WLB）诊断肺癌及癌前病变的灵敏度及特异度等相关指标，并探讨在临床支气管镜检查中常规应用AFB 技术的可行性及优越性。方法：在 PubMed、中国生物医学文献数据库、维普医药信息资源系统和万方数据库中检索2006年至2016年的相关文献。用 Meta - Disc 1.4和 STATA 11.0运算 AFB 与 WLB 在诊断肺癌及癌前病变方面总的效果。结果：共纳入7项研究（AFB 组1330例，WLB 组1329例）。WLB 诊断肺癌的平均灵敏度为0.74（95% CI：0.71～0.78），AFB 诊断肺癌的平均灵敏度为0.91（95% CI：0.88～0.93）。WLB 诊断肺癌的平均特异度为0.82（95% CI：0.78～0.84），AFB 诊断肺癌的平均特异度为0.69（95% CI：0.65～0.72）。结论：AFB 较 WLB 对肺癌的诊断有更高的灵敏度，特异度相对较低，操作方便，安全可靠，可常规用于临床支气管镜检查。     

血清前列腺特异性抗原联合血清肿瘤相关物质在早期前列腺癌诊断中的应用分析

目的分析血清前列腺特异性抗原(PSA)联合血清肿瘤相关物质(TAM)在早期诊断前列腺癌中的应用价值。方法选择128例前列腺癌患者为病例组,另选择128例前列腺良性病变者为对照组,检测所有患者PSA及TAM值,分析PSA联合TAM在早期诊断前列腺癌中的应用价值。结果以PSA≥4.08 ng/ml为诊断前列腺癌的临界值,PSA诊断前列腺癌的准确度、特异度以及灵敏度分别为82.8%、76.1%和88.6%,受试者工作特征(ROC)曲线下面积为0.873。以TAM≥98.36 U/ml为诊断前列腺癌的临界值,TAM诊断前列腺癌的准确度、特异度以及灵敏度分别为77.3%、78.7%和74.5%,ROC曲线下面积为0.832。实施双指标联合检测,特异度为96.6%,高于单一指标诊断特异度。病例组患者TAM和PSA水平均高于对照组,差异均有统计学意义(P﹤0.05)。结论在进行筛查以及早期诊断前列腺癌中,采用PSA及TAM联合检测法,可提升诊断特异度,令检查结果更为精准,值得进一步在临床中推广应用。     

血清-NTx对肺癌、乳腺癌患者诊断骨转移及预后评价价值的Meta分析

目的 用Meta分析方法评估骨代谢标志物血清-NTx（Ⅰ型胶原交联氨基末端肽）对肺癌乳腺癌患者骨转移诊断和预后的价值。方法 利用计算机检索PubMed、Cochrane Library、EMBase、中国知网、万方和维普等数据库,收集涉及骨代谢标志物血清-NTx肺癌乳腺癌患者骨转移诊断及预后的临床研究,按文献纳入排除标准筛选文献,评价文献质量,提取数据资料,应用Stata 12.0软件进行Meta分析。结果 共纳入文献11篇,其中英文文献6篇,中文文献5篇,有关NTx对肺癌乳腺癌骨转移诊断研究8篇,预后研究2篇,1篇文献同时涉及诊断与预后的研究。共计1203例研究对象,肺癌患者726例,乳腺癌患者372例。诊断骨转移：合并灵敏度为76.5 ％ （95％CI： 61.5％～86.9％）,合并特异度为83.3％ （95％CI： 77.1％～ 88.1％）;总生存期的风险比（HR）：初治高血清-NTx者与低血清-NTx者比较,合并HR=1.208 （95％CI： 1.128～1.293,P＜0.05）。结论 NTx对肺癌乳腺癌患者诊断骨转移和评估预后具有较高的临床价值。     

99mTc标记PSMA小分子抑制剂靶向前列腺癌分子影像初步临床研究

背景与目的：前列腺特异性膜抗原(prostate-speciifc membrane antigen,PSMA)在前列腺癌细胞表面特异性高表达,是前列腺癌诊断和治疗的极具有吸引力的靶点。放射性核素标记的PSMA小分子抑制剂能够高效、特异性探测前列腺癌病灶并进行分期。本研究初步探讨99mTc标记PSMA小分子抑制剂(HYNIC-Glu-Urea-A,简称99mTc-PSMA)SPECT/CT显像诊断前列腺原发灶和转移灶的价值。方法：24例前列腺癌和1例前列腺增生患者静脉注射99mTc-PSMA 2 h后行全身平面扫描和腹盆部SPECT/CT断层显像,采用感兴趣区技术计算肿瘤和肌肉摄取99mTc-PSMA比值(T/N)进行半定量分析,评价全身平面显像结合断层显像检测前列腺癌原发灶和(或)转移灶的灵敏度和特异度,分析99mTc-PSMA阳性率与前列腺癌特异性抗原(prostate-speciifc antigen,PSA)水平和Gleason评分的关系。结果：以患者为单位,99mTc-PSMA SPECT/CT对前列腺癌原发灶或转移灶检测的灵敏度为72.7%(16/22)、特异度为100%(3/3)。99mTc-PSMA阳性患者,(中位数17.31 ng/mL,范围2.26~3239.00 ng/mL)水平明显高于99mTc-PSMA阴性患者PSA(中位数0.49 ng/mL,范围0.07~9.28 ng/mL)(Z=-3.51,P<0.001);在初诊和PSA大于2 ng/mL的复发患者中,99mTc-PSMA阳性率明显提高,灵敏度达94.1%(16/17);99mTc-PSMA的阳性率与Gleason评分高低无关(Z=-0.69,P=0.52)。结论：99mTc-PSMA全身平面显像结合局部SPECT/CT断层显像对前列腺癌原发灶和转移灶的探测有较高应用价值,灵敏度及特异度均较高。     

MOC-31在鉴别良恶性浆膜腔积液中诊断价值的Meta分析

目的 通过荟萃分析以确定MOC-31在鉴别良恶性浆膜腔积液中的诊断价值。方法检索国内外数据库,采用诊断性试验荟萃分析的标准方法对纳入文献进行系统评价,汇总各研究中MOC-31在鉴别良恶性浆膜腔积液的灵敏度、特异度、阳性似然比、阴性似然比及诊断优势比,并绘制总的受试者工作特征曲线（SROC）。结果 最终纳入16项独立研究进行荟萃分析,共1602例样本。MOC-31诊断恶性浆膜腔积液的灵敏度为0.90（95％CI：0.88～0.92）,特异度为0.98（95％CI：0.96～0.99）,阳性似然比为18.43（95％CI：11.38～29.84）,阴性似然比为0.11（95％CI：0.07～0.17）,诊断优势比为349.19（95％CI：138.73～878.95）。灵敏度与特异度交点最大值为0.96。结论 MOC-31在鉴别良恶性浆膜腔积液中的灵敏度与特异度较高,SROC曲线显示其诊断效率较高,具有较广阔的临床应用前景。     

动态增强磁共振对前列腺癌术后复发或残留诊断的Meta分析

  目的  评价动态增强磁共振（dynamic contrast-enhanced MRI,DCE -MRI）对前列腺癌（PCa）手术治疗后局部复发或残留的诊断效能。   方法  检索PubMed、EMBASE、Cochrane Library、SCI、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）、万方数字化期刊群等数据库,再根据已发表文献中的参考文献追溯进行手工检索。检索时间截止到2013年6月6日。依据纳入排除标准筛选文献,参照QUADAS评价纳入研究的质量并提取数据,利用Meta-Disc 1.4软件进行统计分析,计算总敏感度、特异度、诊断比值比（dOR）及其95%可信区间（95% CI）和SROC曲线下面积（AUC）。   结果  检索得到118篇文献,有7篇文献（12项研究）符合纳入标准。对12项研究进行Meta分析,总敏感性为0.88（95%CI:0.84~0.91）,总特异性为0.87（95%CI:0.81~0.92）,dOR为50.4（95%CI:26.0~97.6）。DCE-MRI对PCa术后复发或残留诊断的SROC AUC为0.9391,Q*指数为0.8764。   结论  动态增强磁共振对诊断前列腺癌治疗后局限性复发或残留具有较高的敏感性与特异性,其中DCE与磁共振波谱（magnetic resonance spectroscopy,MRS）联合诊断效能更高。      

2型糖尿病患者罹患生殖系统恶性肿瘤危险性的Meta分析

[目的]探讨2型糖尿病与生殖系统恶性肿瘤发生风险的关系。[方法]检索1979年1月至2012年10月Medline、Embase和Web of Science数据库公开发表的有关2型糖尿病与生殖系统恶性肿瘤关系的队列研究文献,按纳入和排除标准进行筛选,利用R软件及其Meta程序包对检索结果进行综合分析。[结果]共纳入39篇文献,包括10778543名观察对象。与非糖尿病人群相比,2型糖尿病患者发生生殖系统恶性肿瘤的合并相对危险度（RR）为1．15（95％CI：1．03～1．28）。2型糖尿病与女性生殖系统恶性肿瘤发生的相对危险度RR为l-39f95％CI：1．23－1．57）。2型糖尿病可以增加子宫内膜癌、宫颈癌和女性乳腺癌的发病风险,合并RR分别为1．83（95％CI：1．58-2．12）、2．13（95％CI：1．86－2．43）和1．16f95％CI：1．03-1.32）。卵巢癌风险的增加接近临界（RR=I．21,95％CI：0．99～1．48）;与前列腺癌的发病风险无关（RR=0．92,95％CI：0．78～1．09）。亚组分析提示,在欧美人群中2型糖尿病患者发生前列腺癌的风险降低．RR为0．80（95％CI：0．74－0．87）。[结论]2型糖尿病可能是子宫内膜癌、宫颈癌、乳腺癌的危险因素之一,可能是欧美人群前列腺癌保护因素。     

PSA与AR联合检测在前列腺癌诊断及预后评价中的作用

目的 探讨PSA与AR联合检测在前列腺癌诊断及短期复发预后评价中的作用.方法 选取前列腺病变患者201例,其中前列腺癌98例、良性前列腺增生103例;另选取可比的正常对照组110例.测定雄激素受体以及各组患者血清中PSA表达水平.比较并评价诊断价值与对预后的影响.使用SPSS16用于数据分析.结果 前列腺癌组患者PSA水平(15.32±6.02)ng/ml,AR阳性率为60.20%;前列腺良性增生组103例患者,PSA水平(6.73±4.02)ng/ml,AR阳性率为74.76%;健康对照110例,平均年龄(45.88±1.98)岁,血清PSA水平(0.71±0.02)ng/ml.组间比较结果提示PSA水平和AR阳性率均以前列腺癌组的水平最高,P＜0.01.血清PSA单独用于前列腺癌诊断的真实性分析的灵敏度为87.76%(86/98),特异度为84.47%(87/103);血清AR单独用于前列腺癌诊断的真实性分析的灵敏度为80.61%(79/98),特异度为63.11%(65/103);而两个指标联合诊断的灵敏度为92.86%(91/98),特异度为89.32%(92/103).随访1年观察短期预后,在单因素Logistics回归分析结果的基础上在进行多因素Logistics回归分析,结果提示与复发存在潜在关联的因素包括PSA表达增高,其OR值为1.395(1.217~1.599),P＜0.001;AR 阳性也是复发的潜在危险因素,OR值为 1.094(1.051~1.139),P＜0.001;二者联合均表现为表达增高也会增高复发的风险,OR值最高,为1.870(1.338~2.614),P＜0.001.结论 PSA与AR联合检测在前列腺癌诊断中灵敏度和特异度均较好,且优于单独使用;同时联合两个指标对于预测近期复发也有一定的价值.     

HER2-neu表达与胃癌预后关系的Meta分析

目的探讨肿瘤组织中HER2-neu表达与胃癌预后的相关性。方法计算机检索相关文献,运用Meta分析方法对纳入文献进行综合定量分析。计算合并相对危险比（HR）和95%可信区间（95% CI）。结果入选文献20篇,包括患者总数为4 398例。有单因素分析结果的文献16篇,一致性检验Q值为27.48（P=0.025）,合并HR为1.57（95%CI 1.30～1.90）;合并多因素分析结果的文献5篇,一致性检验Q值为4.03（P=0.401）,合并HR为1.30（95%CI 1.09～1.52）。结论HER2-neu是胃癌预后不良的一个生物标志物。     

血清PSA联合PSAD检测对前列腺癌的诊断价值

目的:探讨血清前列腺特异抗原（PSA）、前列腺特异抗原密度（PSAD）对前列腺癌的诊断价值。方法:检测经病理确诊的57例前列腺癌、125例前列腺增生患者的血清PSA。经直肠超声测定其前列腺的体积（PV）并计算PSAD。结果:前列腺癌组患者的PSA、PSAD明显高于前列腺增生组(P<0.05)。PSA值在4.1-10.0,10.1-20.0,>20.0ng/ml区间时PCa诊断率分别为8.8%,36.8%,54.4%。前列腺癌组的ROC曲线图中PSAD的AUC值（0.682）高于PSA的AUC值（0.601）,当取PSAD≥0.18ng/（ml·cm3）时,敏感性为84.5%,特异性为78.6%。比较58例重复穿刺患者的PSA、PSAD,只有PSAD差异有统计学意义(P<0.05)。结论:PSA动态监测结合PSAD是重复穿刺的重要参考指标,PSAD是PSA对前列腺癌诊断的有益补充。     

Prostate-specific antigen testing of older men.

BACKGROUND: Elevated serum prostate-specific antigen (PSA) levels are predictive of a future diagnosis of prostate cancer. To test the hypothesis that older men with low PSA levels may require less intensive PSA testing because of a reduced prostate cancer detection rate, we evaluated the association between age, baseline PSA level, and prostate cancer detection. METHODS: We conducted a prospective cohort study among participants in a study of aging who had serial PSA measurements taken from age 60 or 65 years until they either were diagnosed with prostate cancer (cancer case subjects) or reached the age of 75 years (subjects without prostate cancer). The time of cancer detection among cancer case subjects was defined as the measurement date on which a PSA level above 4.0 ng/mL was detected (i.e., PSA conversion). Cancer case subjects and subjects without prostate cancer were analyzed according to baseline PSA level and age. RESULTS: All cancer case subjects in the 60-year-old cohort had baseline PSA levels above 0.5 ng/mL, and 14 of 15 cancer cases that would have been detected by a PSA conversion among the 65-year-old cohort were associated with baseline PSA levels of 1.1 ng/mL or more. If PSA testing were discontinued in men aged 65 years with PSA levels of 0.5 ng/mL or less, 100% (95% confidence interval [CI] = 78%-100%) of the cancers would still be detected by age 75 years; if PSA testing were discontinued in men aged 65 years who had PSA levels of 1.0 ng/mL or less, 94% (95% CI = 70%-100%) of the cancers would still be detected by age 75 years. CONCLUSIONS: These data suggest that a decrease in the intensity of screening among older men with low PSA values may not lead to an increase in undetected prostate cancer.     

Prostate-specific antigen velocity and the detection of gleason score 7 to 10 prostate cancer

BACKGROUND: An increasing prostate-specific antigen (PSA) velocity is associated with a shorter survival after local therapy for prostate cancer. In this study, the authors evaluated whether PSA velocity was associated with prostate cancer detection and grade at diagnosis after adjusting for established predictors. METHODS: Between January 1989 and December 2003, 914 men who had PSA levels >/=4 ng/mL were identified by using the Center for Prostate Disease Research (CPDR) multicenter national database, including 541 men who were diagnosed with prostate cancer. Multivariable logistic regression analyses were performed that included continuous variables (PSA velocity and level, number of prior negative biopsies, and age) along with categorical variables (ethnicity and family history) were used to identify the factors associated with prostate cancer detection and grade. RESULTS: An increasing PSA velocity was associated with Gleason scores from 7 to 10 versus Gleason scores form 2 to 6 or no cancer (adjusted odds ratio [OR], 1.04 ng/mL per year; 95% confidence interval [95% CI], 1.003-1.085 ng/mL per year; P = .035). This finding was not evident in patients who had prostate cancers with Gleason scores between 2 and 6 or for any prostate cancer. PSA level was associated with the detection of any prostate cancer (OR, 1.06 ng/mL; 95% CI, 1.03-1.10 ng/mL; P = .004) and Gleason score 4 ng/mL. These findings, in conjunction with life expectancy, may be used when deciding which men should not be recommended for prostate biopsy despite a PSA level >4 ng/mL.     

Advances in the application of prostate-specific antigen in the detection of early-stage prostate cancer

Prostate-specific antigen (PSA) has revolutionized the detection of prostate cancer. PSA-based screening has been shown to be effective in detecting prostate cancer at an early, potentially curable stage; however, this tumor marker is limited by appreciable false-positive and false-negative results. This is especially problematic when the PSA level is in the upper limit of normal (2.5 to 4.0 ng/mL) or the intermediately increased range (4.1 to 10.0 ng/mL). Several PSA-related indexes and assays have been proposed in an attempt to improve the power of PSA in the early detection of prostate cancer: PSA density (PSAD), age-referenced PSA, volume-referenced PSA, PSAD of the transition zone (PSA-TZ), ProstAsure Index, (Global Health Net, Savannah, GA) and percent free PSA. These indexes may improve the sensitivity and specificity of PSA-based screening, facilitating the early detection of prostate cancer and reducing the number of unnecessary biopsies.     

分子标志物在前列腺癌早期诊断中的进展

较多的研究显示,血清PSA值指导前列腺癌(prostate cancer,Pca)早期诊断的优势不足,例如PSA值在4～10 ng/mL.时,Pca穿刺阴性率占70%～80%.然而,阴性的穿刺结果并不能完全排除肿瘤的存在.寻找敏感性和特异性更高的肿瘤生物标志物一直是Pca研究的热点.目前,PSA衍生物、PCA3、TMPRSS2:ETS、GSTP1、AMACR、COLPH2、EPCA和肌氨酸以及多瘤标的联合应用研究受到广泛关注.本文中我们综述了这些分子标志物的研究近况,展望了多瘤标组合在Pca早期诊断中的价值和应用前景,为Pca的早期诊断和预后监测提供参考.     

Prostate-specific antigen velocity and prostate cancer gleason grade and stage

BACKGROUND: Increased preoperative prostate-specific antigen (PSA) velocity (PSAV) has been associated with increased prostate cancer mortality and higher Gleason scores. The authors evaluated the relation between PSAV, biopsy Gleason score, and pathologic stage in men who were enrolled in a prostate cancer screening trial. METHODS: Data were analyzed from 1441 men who were enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who received > or =2 PSA screens and were diagnosed with prostate cancer within 1 year of the last screen. PSAV was estimated by using all screening PSA values within 6 years prediagnosis. RESULTS: Both PSA and PSAV were related to biopsy Gleason score. The multivariable odds ratios (OR), controlling for PSA and demographics, for having a Gleason score of 7 to 10 were 1.3 (95% confidence interval [95% CI], 0.9-1.9), 2.2 (95% CI, 1.5-3.3), and 2.3 (95% CI, 1.4-3.9) for men with PSAV values from 0.5 to 1 ng/mL per year, from 1 to 2 ng/mL per year, and >2 ng/mL per year, respectively, compared with men who had PSAV values <0.5 ng/mL per year. The median PSAV was 0.60 ng/mL per year for men with Gleason scores from 2 to 6 versus 0.84 ng/mL per year for men with Gleason scores from 7 to 10 (P < .0001). Among 658 men who underwent prostatectomy, both PSA and PSAV were associated with advanced pathologic stage in univariate analyses; however, when the analysis controlled for clinical stage and biopsy Gleason score, the associations of PSA and PSAV were no longer statistically significant. CONCLUSIONS: PSAV and PSA levels were associated independently with biopsy Gleason score. Among men who underwent prostatectomy, PSAV and PSA were not predictive of advanced pathologic stage when the analysis was controlled for biopsy Gleason score and clinical stage. It cannot be determined yet whether PSAV is predictive of long-term prostate cancer outcome in this cohort.     

Serum proteomic patterns for detection of prostate cancer

Pathologic states within the prostate may be reflected by changes in serum proteomic patterns. To test this hypothesis, we analyzed serum proteomic mass spectra with a bioinformatics tool to reveal the most fit pattern that discriminated the training set of sera of men with a histopathologic diagnosis of prostate cancer (serum prostate-specific antigen [PSA] > or =4 ng/mL) from those men without prostate cancer (serum PSA level <1 ng/mL). Mass spectra of blinded sera (N = 266) from a test set derived from men with prostate cancer or men without prostate cancer were matched against the discriminating pattern revealed by the training set. A predicted diagnosis of benign disease or cancer was rendered based on similarity to the discriminating pattern discovered from the training set. The proteomic pattern correctly predicted 36 (95%, 95% confidence interval [CI] = 82% to 99%) of 38 patients with prostate cancer, while 177 (78%, 95% CI = 72% to 83%) of 228 patients were correctly classified as having benign conditions. For men with marginally elevated PSA levels (4-10 ng/mL; n = 137), the specificity was 71%. If validated in future series, serum proteomic pattern diagnostics may be of value in deciding whether to perform a biopsy on a man with an elevated PSA level.     

Specificity of serum prostate-specific antigen determination in the Finnish prostate cancer screening trial

Specificity constitutes a component of validity for a screening test. The number of false-positive (FP) results has been regarded as one of major shortcomings in prostate cancer screening. We estimated the specificity of serum prostate-specific antigen (PSA) determination in prostate cancer screening using data from a randomised, controlled screening trial conducted in Finland with 32 000 men in the screening arm. We calculated the specificity as the proportion of men with negative findings (screen negatives, SN) relative to those with negative and FP results (SN/(SN+FP)). A SN finding was defined as either PSA相似文献   

Prospective study of cancer detection in black and white men with normal digital rectal examination but prostate specific antigen equal or greater than 4.0 ng/mL

BACKGROUND: The serum prostate specific antigen (PSA) concentration with no clinical evidence of prostate carcinoma is higher and more variable in black than in white American men. The influence of this phenomenon on relations between race, PSA, and cancer detection in men with a PSA greater than or equal to 4.0 ng/mL has not been investigated. METHODS: Between January 1992 and December 2000, 451 black and 480 white men with a normal digital rectal examination and a PSA greater than or equal to 4.0 ng/mL had an initial prostate biopsy at one medical center. The histology of the biopsy specimens and the Gleason score of malignant specimens was determined by one uropathologist. RESULTS: Cancer was detected in 207 (46%) black and 167 (35%) white men (P = 0.0006). When adjusted for PSA, cancer detection was also greater in the black than the white men, but the difference did not achieve statistical significance (relative risk, 1.30; 95% confidence interval [CI], 0.99-1.71; P = 0.06). Gleason score 7-10 cancer was detected in 88 (20%) black and 45 (9%) white men (P = 0.0001), and the difference remained significant when adjusted for PSA (relative risk, 1.73; 95% CI, 1.16-2.61; P = 0.0008). In the intermediate PSA range of 4.0-9.9 ng/mL, cancer detection and Gleason score 7-10 cancer detection was greater in black than in white men younger than 60, 60-69, and 70 years of age or older, but the difference was significant only for Gleason score 7-10 cancer detection among men 60-69 years of age (P = 0.006). CONCLUSIONS: There is a direct correlation between Gleason score and cause specific survival with local stage prostate carcinoma. The authors' study indicates that prostate carcinomas with established malignant potential are more likely to be identified in black than in white men with PSA elevation as the only indication of malignancy and raises the possibility that a PSA threshold less than 4.0 ng/mL in black men younger than 70 years of age may reduce racial disparities in prostate carcinoma morbidity and mortality.     

A prospective study of the serum prostate specific antigen concentrations and Gleason histologic scores of black and white men with prostate carcinoma.

BACKGROUND: The stage specific survival rates of black American men with prostate carcinoma are less favorable than those of white American men. The authors conducted a prospective study of the serum prostate specific antigen (PSA) concentrations and Gleason histologic scores of black and white men with newly diagnosed prostate carcinoma to determine whether there were racial differences in these prognostic variables. METHODS: At a Veterans Affairs Medical Center between January 1, 1992, and December 31, 1997, clinical stage, Gleason histologic score, serum PSA concentration, prostate volume, and PSA density were determined for 796 consecutive men (465 black and 331 white) who had biopsy-detected prostate carcinoma. RESULTS: The percentages, respectively, of black and white men with local, regional, and metastatic carcinoma were 58 and 72; 22 and 17; and 20 and 11 (P < 0.0001). Of 271 black and 329 white men with local stage cancer, 20% and 12%, respectively, had Gleason 8-10 tumors (P = 0.02), and the age-adjusted risk of Gleason 8-10 cancer was 1.39 times greater for black men (95% confidence interval [CI] = 1.09-2.93). Gleason 8-10 cancer was found in 12 of 68 black (18%) and 5 of 87 white (6%) men with local cancer who were age 65 years or younger (P = 0.02). Among black and white men with local stage cancer, the mean PSA was 12.9 (95% CI = 11.5-14.4) and 8.5 (95% CI = 7.6-9.4) ng/mL, respectively (P < 0.0001), and among black and white men with regional stage cancer the mean PSA was 53.3 (95% CI = 42.7-63.9) and 35.0 (95% CI = 27.3-42.6) ng/mL, respectively (P = 0.02). The mean PSA of black and white men with local cancer who were age 65 years or younger was 11.6 (95% CI = 8.8-14.4) and 6.9 (95% CI = 5.9-8.0) ng/mL, respectively (P = 0.0009). CONCLUSIONS: Disparities in the risk of Gleason score 8-10 cancer for black and white men with local stage disease and in the serum PSA concentrations of black and white men with local and regional stage disease help to explain racial differences in cancer survival. Racial differences in the risk of Gleason 8-10 cancer and in the serum PSA concentrations of men age 65 years or younger have implications regarding the potential benefits of screening for prostate carcinoma in the African American community.