Which factor would elevate concern for prostate cancer in a patient with a prostate-specific antigen level of 4.0?

An elevated concern for prostate cancer in a patient with a prostate-specific antigen (PSA) level of 4.0 can be significantly influenced by a variety of factors, and one of the most notable is race. African-American men have been shown to have a higher incidence and mortality rate from prostate cancer compared to men of other racial and ethnic backgrounds. This increased risk necessitates a more vigilant approach when assessing PSA levels in this group, where even modest elevations in PSA could warrant further investigation for prostate cancer.

The biological reasons behind this disparity may relate to genetic predispositions and differences in tumor biology, which can affect how prostate cancer develops and progresses in African-American men. As a result, the presence of an elevated PSA level in this demographic heightens the suspicion for prostate cancer, leading to recommendations for earlier or more aggressive screening and diagnostic procedures.

In contrast, while the other factors listed may have certain associations with prostate health, they do not carry the same degree of risk suggestion as race. For instance, exposure to certain chemicals, a history of benign prostatic hyperplasia, or smoking may be relevant in broader studies or specific contexts, but they do not represent the same heightened immediate concern for prostate cancer as the racial factor does in practice.