Oleksandr N. Kryvenko, Jonathan I. Epstein, Richard J. Cote

To evaluate PSA production by benign prostate tissue and Gleason score 3+3=6 (Grade Group 1) prostate cancer in Black and White Non-Hispanic men. We used Gleason score 3+3=6 (Grade Group 1) cases to assess PSA production by benign prostate tissue in cases with low-volume cancer that did not influence PSA and in those with high-volume cancer in which gland weight did not influence PSA. We then created age, PSA, and prostate weight adjusted cohorts to demonstrate tumor volume per 1 ng/ml of PSA and 1 μg of PSA mass. PSA density (PSAD) and PSA mass density (PSAMD) were used to adjust for prostate weight. Comparison of 58 Black and 301 White men with low-volume cancer demonstrated equal PSA production by benign prostate tissue. Comparison of 30 Black and 75 White men with high-volume cancer indicated that PSA was being driven by cancer volume, with lower PSA production in Black men. In the cohort of 54 Black and 134 White men matched by age, PSA, and prostate weight, tumor volumes per 1 ng/ml of PSA or 1 μg of PSA mass adjusted for prostate weight were 25% and 26% higher in Blacks, correspondingly. Benign prostate tissue produces equal amounts of PSA in Black and White men. Gleason score 3+3=6 (Grade Group 1) prostate cancer produces less PSA in Black men. These data should be considered for lowering PSA and its derivatives in determining biopsy thresholds and for adjusting values for active surveillance criteria in Black men.