Predicting Pathological Stage of Localized Prostate Cancer

To the Editor.  —Dr Partin and colleagues¹ have ignored the race of the patient in reporting their nomograms that are intended to predict the pathological stage of clinically localized prostate cancer. Not only does this limit the generalizability of the nomograms, but it also influences their accuracy. Black race has been shown to be an adverse prognostic factor for recurrence following radical prostatectomy, even after multivariate adjustment for the 3 factors that the nomograms use in predicting stage (serum PSA level, clinical stage, and tumor grade in biopsy).² The prostate cancer death rate is 52% higher for black Americans than white Americans, and the 5-year relative survival rate is 16% lower, despite the fact that the percentage of blacks that present with "localized" disease (53%) is similar to whites (59%).³ Compared with white men, the percentage of black men with margin-positive disease is significantly higher (50.5% vs 38.4%; P=.04)