Objectives. To determine whether biopsy-detectable transition zone tumors are more common in black than in white men with suspected Stage T1c and T2 prostate cancer.

Methods. We performed a prospective study of transition zone prostate biopsy (TZ biopsy) in 178 black and 261 white men who had not undergone previous prostate biopsy and in 61 black and 65 white men who had undergone one benign sextant peripheral zone prostate biopsy (PZ biopsy).

Results. The mean age of the 239 black and 326 white study patients was 68.6 ± 7.4 and 67.2 ± 7.2 years, respectively (P = 0.02), the mean prostate-specific antigen (PSA) was 8.4 ± 7.4 and 6.4 ± 5.4 ng/mL, respectively (P = 0.003), and the mean PSA density was 0.20 ± 0.23 and 0.16 ± 0.16 ng/mL/mL, respectively (P = 0.006). Overall, cancer was diagnosed by TZ biopsy only in 7 black men (3%) and in no white men (0%) (P = 0.003). However, cancer detection with a TZ biopsy only was not significantly different in the black and white men when controlled for age, PSA, or PSA density (P > 0.90). A TZ biopsy only detected cancer in 1% of patients who had not undergone prior PZ biopsy and in 2% of patients who had undergone prior PZ biopsy. Of the seven cancers detected with TZ biopsy, six (86%) had a Gleason score of 2 to 6.

Conclusions. Prostate cancer detection with a TZ biopsy only is not common and when controlled for confounding variables is the same in black and white men. The preferential use of TZ biopsies in black men is not warranted, and the low diagnostic yield argues against routine use of the biopsy technique in men of either race.