Race and the Will Rogers phenomenon in prostate cancer.

Abstract

Over the past decade, African-Americans have shown a decline in tumor cell burden at the time of diagnosis as reflected by a decline in mean levels of prostate-specific antigen. For whites and African-Americans, there has been a shift to early clinical stages. The Will Rogers phenomenon, as demonstrated in African-Americans by decline in prostate-specific antigen and in whites and African-Americans by clinical stage migration, indicates lead-time and length biases, resulting in a more favorable disease profile at diagnosis for both groups. The decline in prostate-specific antigen among African-Americans indicates that the initial higher tumor cell burden seen in the past was caused by socioeconomic factors rather than inherited differences, and is likely to be ameliorated with widespread prostate-specific-antigen screening.