This article has discussed the increased incidence and disproportionately 
increased mortality of prostate cancer among African American men.Although the 
exact reasons are unknown, genetics may play a role, in addition to health care 
practices. Morbidity from other disease states, such as diabetes, obesity, or 
hypertension, may influence the overall survival of patients with prostate 
cancer. Current research tools will continue to explore biologic differences 
between the races; however, socioeconomic status and access to health care must 
not be overlooked. Several studies have demonstrated that similar disease stages 
and equal access to health care will result in similar outcomes. It is 
recognized that screening for prostate cancer will remain a controversial topic. 
Several influential professional societies recommend against screening and other 
professional societies endorse screening. Large-scale trials are currently 
underway hoping to answer this critical question. Since the advent of current 
screening tools, however, it seems that the overall mortality for prostate 
cancer has decreased and this cannot be ignored. Certainly, screening programs 
and clinical trials have traditionally had difficulty in recruiting minority 
participants, although more recent trials seem to be finding success. A primary 
care physician who is viewed as competent by their patients can certainly have a 
positive impact on their African American patients' willingness to participate 
in studies and screening programs. Most importantly, on the individual level, 
primary care physicians can provide a great service to their minority patients 
by offering educational materials on prostate cancer and by offering screening 
to qualified patients. The current American Urologic Association and National 
Cancer Institute guidelines recommend offering screening to all men age 50 and 
above. African American men or men with a first-degree relative with prostate 
cancer should be offered screening beginning at age 40. Proper screening 
consists of both a digital rectal examination to assess for asymmetry or nodules 
of the prostate and a serum PSA. Current recommendations are that individuals 
with a serum PSA greater than 4 ng/mL ora prostate nodule or asymmetric prostate 
should be referred to an urologist,where a biopsy can be performed easily in the 
office setting.The PSA cutoff of 4 has recently been questioned. A study by 
Thompson et al [31] evaluated 2950 men with a PSA of 4 or less with prostate 
biopsy.They found that the risk of prostate cancer in men with a PSA between 3.1 
and 4 was 26.9% and that 25% of these men with prostate cancer had high-grade 
disease. All men found to have cancer had T1 disease. The clinical relevance of 
this surprisingly high rate of prostate cancer in men with a normal PSA is yet 
to be determined and is pending in studies on the ultimate effect of screening 
on mortality from prostate cancer. This information is not intended to confuse 
the issue, but intended to provide the most up-to-date information and allow for 
the best clinical decision making by the primary care physician. What can 
currently be recommended is if a patient is concerned about his possibility of 
having prostate cancer despite a normal PSA, a referral to an urologist to at 
least further discuss the issue may be in order. This may be especially true if 
the patient is African American or has a family history of prostate cancer at an 
early age.