From the Winter 2014 Johns Hopkins “Discovery”

It has long been known that prostate cancer behaves more aggressively in black men than in caucasians and asians. However, a review of radical prostatectomy specimen found that, while high grade cancer tends to form in the posterior gland (where biopsies focus) in whites, 60% of high grade tumors in blacks form in the anterior gland which is more difficult to sample and commonly not in routine biopsy schemes. Hence, management with Active Surveillance may be more risky in black men in whom their most aggressive tumor sites may not be discovered, and they would be assumed to have only non-aggressive cancer. A multiparametric MRI of the prostate would be helpful to rule out these hidden high grade tumors before settling on Active Surveillance.