Black men less likely to receive follow-up care after positive prostate exam

Non-Hispanic black men were nearly 50% less likely than white men to receive a follow-up procedure after a positive initial PSA screening, study results showed.

Daniel A. Barocas, MD, MPH, and colleagues aimed to determine the role of race in follow-up diagnostic testing after a positive screening evaluation.

The researchers culled data from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. The analysis included men with PSA levels of more than 4 ng/mL at any time during the study.

The primary evaluable measure was the proportion of men who underwent a repeat PSA screening, a prostate biopsy or both within 9 months of the initial positive test.

Men were stratified by age (<65 years and ≥65 years).

The final data set included 6,294 men. Seventy percent underwent a repeat PSA or a biopsy within the 9-month window.

Non-Hispanic black men aged younger than 65 years were 45% less likely to undergo a repeat procedure compared with non-Hispanic white men (OR=0.55; 95% CI, 0.37-0.82).

No differences in follow-up rates were observed among men in the older cohort.

“The current results suggest that limitations in access to care among non-Hispanic black men under the age of Medicare eligibility may underlie the paradoxically low use of follow-through diagnostic care among non-Hispanic black men in the United States,” Barocas and colleagues concluded.

Durado D. Brooks

The finding “is especially troubling in light of the 60% higher incidence of prostate cancer among black men and their 200% higher mortality,” Durado D. Brooks, MD, MPH, director of prostate and colorectal cancers for the American Cancer Society, wrote in an accompanying editorial.

There are several potential explanations for the disparity, Brooks wrote.

At the patient level, black men often have “significant knowledge gaps” about prostate cancer that may prevent them from following through with services, he said.

At the provider level, black men are more likely than whites to have difficulties accessing health care, Brooks said. Moreover, “there was no apparent provision in the PLCO protocol to connect men with care in the absence of established medical relationships,” he wrote.

The main health system issue may be a lack of insurance coverage among black men, according to Brooks.

Clinicians should consider the ACS recommendations for informed decision making.

“This approach aims to educate men regarding what is known and what is not known about screening for [prostate cancer] and encourages them to make the decision whether or not to be screened based on their personal values and preferences,” Brooks wrote.

For more information:

Barocas DA. Cancer. 2013;doi:10.1002/cncr.28042.

Brooks DD. Cancer. 2013;doi:10.1002/cncr.28041.