Korean Prostate Cancer Patients Have Worse Disease Characteristics than their American Counterparts

Background: Although the PSA test has been used in Korea for over 20 years, the incidence of prostatecancer has risen, and the associated mortality has increased about 13-fold over the 20-year period. Also, severalinvestigators have suggested that Asians in America are more likely to present with more advanced prostate cancerthan Caucasians. We compared the characteristics of native Koreans and Americans (Caucasians and African-Americans) undergoing radical prostatectomies in Korea and the US. Materials and
Methods: Study subjectscomprised patients at Korean and US hospitals from 2004 to 2012 who had undergone radical prostatectomies.We compared the characteristics of the subjects, including age, preoperative prostate-specific antigen (PSA) levels,body mass index (BMI), Gleason score, and pathological T stage.
Results: In total, 1,159 males (502 Koreans, 657Americans) were included. The Korean and American patients had mean ages of 67.1±6.6 and 59.2±6.7 years,respectively. The mean preoperative PSAs were 15.4±17.9 and 6.2±4.6 ng/mL (p=0.0001) and the mean BMIswere 23.6±2.6 and 28.7±4.4 kg/m2 (p=0.0001), respectively. Pathological localized prostate cancer represented71.7% of cases for Koreans and 77.6% for Americans (p=0.07). According to age, Koreans had higher T stagesthan Americans in their 50s (p=0.021) and higher Gleason scores than Americans in all age groups. Accordingto PSA, Koreans had higher Gleason scores than Americans for PSA >10 ng/mL (p<0.05). According to prostatesize and Gleason scores, Koreans had higher PSA values than Americans (p<0.01).
Conclusions: These resultsshow that Korean patients have elevated risk of malignant prostate cancers, as indicated by the significantlyhigher Gleason scores and PSAs, suggesting a need for novel prostate cancer treatment strategies in Korea.