Increased Low Density Lipoprotein and Increased Likelihood of Positive Prostate Biopsy in Black Americans

Moses, Kelvin A.; Abd, Thura T.; Goodman, Michael; Hsiao, Wayland; Hall, John A.; Marshall, Fray F.; Petros, John A.; Issa, Muta M.

doi:10.1016/j.juro.2009.07.039

« Previous Next »The Journal of Urology
Volume 182, Issue 5 , Pages 2219-2225, November 2009

Increased Low Density Lipoprotein and Increased Likelihood of Positive Prostate Biopsy in Black Americans

Kelvin A. Moses
- Department of Urology, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
Thura T. Abd
- Department of Urology, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
Wayland Hsiao
- Department of Urology, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
John A. Hall
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
Fray F. Marshall
- Department of Urology, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Financial interest and/or other relationship with American Urological Association.
John A. Petros
- Department of Urology, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia
Muta M. Issa
- Department of Urology, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Department of Urology, Emory University School of Medicine, Emory University, Atlanta, Georgia
- Correspondence: Department of Urology, Atlanta Veterans Affairs Medical Center (112), 1670 Clairmont Rd., Northeast, Decatur, Georgia 30033 (telephone: 404-728-4144; FAX: 404-329-2201)

Received 16 March 2009 published online 16 September 2009.

Purpose

Differences in prostate cancer incidence, grade and stage at diagnosis, and survival in black vs nonblack men are well documented. Recent studies indicate that lipids may have a role in oncogenesis, including that of prostate cancer. We investigated the relationship between circulating lipids in black and nonblack patients, and newly diagnosed prostate cancer.

Materials and Methods

The study population included consecutive patients who underwent prostate biopsy for increased prostate specific antigen and/or abnormal digital rectal examination at Atlanta Veterans Affairs Medical Center. Age, race, prostate specific antigen, prostate volume, body mass index, family history, high and low density lipoprotein, triglyceride and cholesterol lowering medications were included in data analysis.

Results

A total of 1,775 men with complete information were included in data analysis. A total of 521 black and 451 white men had positive biopsies. Using 100 mg/dl or less as the referent the adjusted OR reflecting the association of low density lipoprotein and prostate cancer diagnosis in black men was 1.49 (95% CI 1.04–2.13, p = 0.031), 1.51 (95% CI 0.96–2.39, p = 0.076) and 3.24 (95% CI 1.59–6.92, p = 0.002) for low density lipoprotein greater than 100 to 130, greater than 130 to 160 and greater than 160 mg/dl, respectively. Corresponding results in nonblack men showed no significant association.

Conclusions

Increased serum low density lipoprotein is associated with an increased likelihood of prostate cancer diagnosis in black men but not in nonblack men. This association is strongest in the highest low density lipoprotein risk category. The reasons for the racial differences are unknown but may include genetic, dietary or other environmental factors.

Key Words: prostate, prostatic neoplasms, African Americans, cholesterol, LDL, risk

Abbreviations and Acronyms: AA, African American, AR, androgen receptor, BMI, body mass index, CaP, prostate cancer, DRE, digital rectal examination, HDL, high density lipoprotein, hMG Co-A, 3-hydroxy-3-methylglutaryl-coenzyme A, LDL, low density lipoprotein, Lp(a), lipoprotein a, PIN, prostatic intraepithelial neoplasia, PSA, prostate specific antigen, TG, triglyceride, VA, Veterans Affairs