To evaluate the relationship between initial prostate-specific antigen (PSA) and prostate cancer (PCa) risk in elderly African American (AA) and Caucasian American (CA) men.

A total of 408 AA and 1720 CA men whose initial PSA measurement was performed between 75 and 80 years of age were retrieved from Duke Prostate Center database. Patients were stratified by race and initial PSA value. The relative risk (RR) of PCa detection was estimated. The rates of high risk PCa, and death from PCa stratified by initial PSA groups were compared using the chi-square test.

The age-adjusted RR of PCa detection in CA men with PSA 3.0-5.9 ng/mL was 1.9-fold higher when compared with that of men with PSA 0.0-2.9 ng/mL (P <.001), but it did not change significantly in AA men (P = .270). PSA 6.0-9.9 ng/mL was associated with age-adjusted RR of PCa 9.3-fold in AA men and 4.1-fold in CA men (both P values <.001). A low rate of high-risk PCa and death from PCa was indicated with PSA <6.0 ng/mL and <3.0 ng/mL and follow-up of a maximum of 19.2 years and 17.6 years, respectively, in AA and CA men.

AA men with initial PSA <6.0 ng/mL and CA men with initial PSA <3.0 ng/mL between 75 and 80 years of age are unlikely to be diagnosed with high risk PCa or death from PCa. It may be safe to discontinue PSA screening in these men.