尽管黑人比非西班牙裔白人更有可能患上前列腺癌并死于前列腺癌，但指导黑人前列腺特异性抗原 (PSA) 筛查方案的数据有限。本研究根据活检前 PSA 水平调查了自我认定的黑人退伍军人患前列腺癌的风险是否高于预期。多变量逻辑回归模型估计可预测 75,295 名黑人和 207,658 名白人在首次活检时诊断出前列腺癌的可能性男性退伍军人。自我认定的种族、首次 PSA 测试时的年龄、活检前 PSA、首次活检时的年龄、吸烟状况、他汀类药物使用和社会经济因素被用作预测因素。根据不同 PSA 水平的逻辑模型，计算了首次前列腺活检时癌症检测的调整预测概率。在控制 PSA 和其他协变量后，黑人退伍军人在第一次前列腺活检时被诊断出前列腺癌的可能性比白人高 50%退伍军人（优势比 [OR]，1.50；95% CI，1.47-1.53​​；p < .001）。在 PSA 水平为 4.0 ng/mL 时，黑人患前列腺癌的概率为 49%，而白人患前列腺癌的概率为 39%。该模型表明，PSA 为 4.0 ng/mL 的黑人退伍军人患前列腺癌的风险与 PSA 为 13.4 ng/mL 的白人退伍军人相当。研究结果表明，在任何给定的 PSA 水平下，黑人男性更有可能罹患前列腺癌。比白人男性更容易患前列腺癌。需要进行前瞻性研究，以更好地评估黑人男性和其他高危人群中 PSA 筛查的风险和益处。© 2023 美国癌症协会。

Although Black men are more likely than non-Hispanic White men to develop and die from prostate cancer, limited data exist to guide prostate-specific antigen (PSA) screening protocols in Black men. This study investigated whether the risk for prostate cancer was higher than expected among self-identified Black than White veterans based on prebiopsy PSA level.Multivariable logistic regression models were estimated to predict the likelihood of prostate cancer diagnosis on first biopsy for 75,295 Black and 207,658 White male veterans. Self-identified race, age at first PSA test, prebiopsy PSA, age at first biopsy, smoking status, statin use, and socioeconomic factors were used as predictors. The adjusted predicted probabilities of cancer detection on first prostate biopsy from the logistic models at different PSA levels were calculated.After controlling for PSA and other covariates, Black veterans were 50% more likely to receive a prostate cancer diagnosis on their first prostate biopsy than White veterans (odds ratio [OR], 1.50; 95% CI, 1.47-1.53; p < .001). At a PSA level of 4.0 ng/mL, the probability of prostate cancer for a Black man was 49% compared with 39% for a White man. This model indicated that Black veterans with a PSA of 4.0 ng/mL have an equivalent risk of prostate cancer as White veterans with a PSA of 13.4 ng/mL.The findings indicate that, at any given PSA level, Black men are more likely to harbor prostate cancer than White men. Prospective studies are needed to better evaluate risks and benefits of PSA screening in Black men and other high-risk populations.© 2023 American Cancer Society.