African American Men have Increased Risk of Prostate Cancer Detection Despite Similar Rates of Anterior Prostatic Lesions and PI-RADS Grade on Multiparametric Magnetic Resonance Imaging



      To determine whether the frequency of anterior prostate lesions (APL) on multiparametric magnetic resonance imaging (mpMRI) prior to biopsy differed between African American (AA) and non-AA men and evaluate implications of race and tumor location for prostate cancer (PCa) detection.


      Patients from the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (January 2015-December 2020) without prior diagnosis of PCa were evaluated for APLs by race. Multivariable logistic regression models evaluated predictors of APLs and associations of APLs and race with detection of any PCa (grade group 1+) and clinically significant PCa (csPCa; grade group 2+). Additional stratified and propensity score matched analyses were conducted.


      Of 1,239 men included, 190 (15.3%) were AA and 302 (24.4%) had at least one APL with no differences by race on multivariable analysis. While men with APLs were twice as likely to harbor PCa or csPCa, the unadjusted proportion of targeted biopsy-confirmed APL PCa (12.6% vs 12.0%) or csPCa (8.4% vs 8.9%) were similar for AA and non-AA men. AA men had higher risk of prostate cancer on targeted cores (OR 1.66 (95%CI 1.06 – 2.61), P = 0.026) which was independent of lesion location or PI-RADS.


      AA men were found to have similar rates of APLs on mpMRI to non-AA men indicating access to mpMRI may mitigate some of the historical racial disparity based on lesion location. AA men have increased risk of PCa detection compared to non-AA men independent of anterior location or lesion grade on mpMRI reinforcing the importance of identifying genetic, biologic, and socioeconomic drivers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Chornokur G, Dalton K, Borysova ME, et al. Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer.

        • Powell IJ
        Epidemiology and pathophysiology of prostate cancer in African-American men.
        J Urol. 2007; 177: 444
        • Shenoy D
        • Packianathan S
        • Chen AM
        • et al.
        Do african-american men need separate prostate cancer screening guidelines?.
        BMC Urol. 2016; 16: 19
        • Zeng C
        • Wen W
        • Morgans AK
        • et al.
        Disparities by race, age, and sex in the improvement of survival for major cancers: results from the national cancer institute surveillance, epidemiology, and end results (SEER) program in the united states, 1990 to 2010.
        JAMA Oncol. 2015; 1: 88-96
        • Steele CB
        • Li J
        • Huang B
        • Weir HK.
        Prostate cancer survival in the united states by race and stage (2001-2009): findings from the CONCORD-2 study.
        Cancer. 2017; 123: 5160-5177
        • Ritch CR
        • Morrison BF
        • Hruby G
        • et al.
        Pathological outcome and biochemical recurrence-free survival after radical prostatectomy in african-american, afro-caribbean (jamaican) and caucasian-american men: an international comparison.
        BJU Int. 2013; 111: 186
        • Major JM
        • Norman Oliver M
        • Doubeni CA
        • et al.
        Socioeconomic status, healthcare density, and risk of prostate cancer among african american and caucasian men in a large prospective study.
        Cancer Causes Control. 2012; 23: 1185
        • Platz EA
        • Rimm EB
        • Willett WC
        • et al.
        Racial variation in prostate cancer incidence and in hormonal system markers among male health professionals.
        J Natl Cancer Inst. 2000; 92: 2009
        • Powell IJ
        • Dyson G
        • Land S
        • et al.
        Genes associated with prostate cancer are differentially expressed in african american and european american men.
        Cancer Epidemiol Biomarkers Prev. 2013; 22: 891
        • Brawley OW
        • Jani AB
        • Master V
        Prostate cancer and race.
        Curr Probl Cancer. 2007; 31: 211-225
        • Tiguert R
        • Gheiler EL
        • Tefilli MV
        • et al.
        Racial differences and prognostic significance of tumor location in radical prostatectomy specimens.
        Prostate. 1998; 37: 230-235
        • Sundi D
        • Kryvenko ON
        • Carter HB
        • Ross AE
        • Epstein JI
        • Schaeffer EM
        Pathological examination of radical prostatectomy specimens in men with very low risk disease at biopsy reveals distinct zonal distribution of cancer in black american men.
        J Urol. 2014; 191: 60-67
        • Fine SW
        • Reuter VE
        Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer.
        Histopathology. 2012; 60: 142
        • Faisal FA
        • et al.
        Racial variation in prostate cancer molecular subtypes and androgen receptor signaling reflects anatomic tumor location.
        J Euro Urol. 2016; 70: 14-17
        • Mygatt J
        • Sesterhenn I
        • Rosner I
        • et al.
        Anterior tumors of the prostate: clinicopathological features and outcomes.
        Prostate Cancer Prostatic Dis. 2014; 17: 75-80
        • Falagario UG
        • Ratnani P
        • Lantz A
        • et al.
        Staging accuracy of multiparametric magnetic resonance imaging in caucasian and african american men undergoing radical prostatectomy.
        J Urol. 2020; 204: 82-90
        • Ankerst DP
        • Hoefler J
        • Bock S
        • et al.
        Prostate cancer prevention trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer.
        Urology. 2014; 83: 1362-1367
      2. Patel HD, Koehne EL, Shea SM, et al. Risk of prostate cancer for men with prior negative biopsies undergoing magnetic resonance imaging compared to biopsy naïve men: a prospective evaluation of the PLUM cohort. Cancer.

        • Liu JL
        • Patel HD
        • Haney NM
        • et al.
        Advances in the selection of patients with prostate cancer for active surveillance.
        Nat Rev Urol. 2021; 18: 197-208
        • Mygatt JG
        • Cullen J
        • Streicher SA
        • et al.
        Race, tumor location, and disease progression among low-risk prostate cancer patients.
        Cancer Med. 2020; 9: 2235-2242
        • Kongnyuy M
        • Sidana A
        • George AK
        • et al.
        The significance of anterior prostate lesions on multiparametric magnetic resonance imaging in african-american men.
        Urol Oncol. 2016; 34: 15-21
        • Wells TS
        • Bukowinski AT
        • Smith TC
        • et al.
        Racial differences in prostate cancer risk remain among US servicemen with equal access to care.
        Prostate. 2010; 70: 727-734
        • Faisal FA
        • Sundi D
        • Tosoian JJ
        • et al.
        Racial variations in prostate cancer molecular subtypes and androgen receptor signaling reflect anatomic tumor location.
        Eur Urol. 2016; 70: 14-17