Racial Variations in PSA and PSA Density Among Men With Negative Prostate Biopsies: A Multicenter Comparative Study of Chinese, African American, and Caucasian American Populations

BACKGROUND: Prostate-specific antigen (PSA) and PSA density (PSAD) are widely used for prostate cancer (PCa) screening, but their diagnostic thresholds have not been differentially adjusted for ethnic groups in clinical practice. This multicenter study aimed to establish the distribution of PSA and PSAD in Chinese men without PCa and compare these values with published data from African American (AA) and Caucasian American (CA) men to assess potential racial disparities. METHODS: We analyzed 528 biopsy-negative Chinese men from two tertiary centers, comparing their age-adjusted PSA/PSAD with published AA/CA data. Additionally, we compared PSA/PSAD distributions and the proportion of men exceeding the conventional PSA cutoff (4 ng/mL) across racial groups. RESULTS: PSA levels showed a weak but significant positive correlation with age (r = 0.121, p = 0.005), whereas PSAD did not (r = -0.032, p = 0.465). Notably, Chinese men without PCa exhibited significantly higher mean PSA and PSAD than AA and CA men (PSA: 17.28 vs. 7.97 vs. 4.30 ng/mL, p < 0.001; PSAD: 0.28 vs. 0.19 vs. 0.11 ng/mL/mL, p < 0.001). Using a PSA cutoff of 4 ng/mL, the specificity for PCa detection was substantially lower in Chinese men than in AA and CA men at matched sensitivity levels. CONCLUSIONS: This study reveals striking racial differences in baseline PSA and PSAD among men without PCa, with Chinese men demonstrating markedly higher values than AA and CA counterparts. These findings challenge the universal application of current PSA thresholds and underscore the need for race-specific adjustments to optimize PCa screening accuracy.