Regular PSA screening may improve prostate cancer outcomes among younger Black men
Greater adherence to PSA screening reduced risk for metastatic and lethal prostate cancer among Black men aged 40 years to 55 years, according to results of an observational study presented during the virtual ASCO Annual Meeting.
These findings suggest PSA screening has the potential to improve prostate cancer outcomes for young Black men and may represent a step toward reducing racial disparities in outcomes for this group, according to the researchers.
“African American men have the highest mortality rate of prostate cancer. PSA screening is a method that’s widely used for early cancer detection and treatment; however, the data for PSA screening actually include very few African American men and no young African American men between the ages of 40 and 55 [years],” Edmund M. Qiao, BS, fourth-year medical student at University of California, San Diego, said during a press conference. “This has led to discordant PSA recommendations from medical societies for these patients. As a result, young African American men are an at-risk group that needs additional research to help guide clinicians and [the patients] when deciding when to start PSA screening.”
Guidelines from U.S. Preventive Services Task Force recommend PSA screening starting at age 55 years. However, guidelines from National Comprehensive Cancer Network and American Urological Association recommend Black men consider screening starting at age 40 years.
Qiao and colleagues sought to examine the association between PSA screening intensity —defined as the percentage of years men underwent screening up to 5 years prior to prostate cancer diagnosis — and disease severity at diagnosis and prostate cancer-specific mortality among Black men aged 40 to 55 years. Researchers measured prostate cancer-specific mortality using Fine-Gray regression, and they assessed the influence of screening on metastatic disease at diagnosis in a multivariable logistic regression analysis that accounted for primary care visit rate, age at and year of diagnosis, Charlson comorbidity score, employment, marital status, college education and income.
The analysis included data of 4,726 Black men (mean age, 51.8 years) diagnosed with prostate cancer within the Veterans Health Administration between 2004 and 2017.
Overall, men in the cohort had an average of 1.9 previous PSA tests and a mean PSA screening rate of 53.2%.
Researchers identified a group of men within their cohort who had high PSA screening intensity, with an average of three previous PSA tests, and a group with low PSA screening intensity, with an average of 0.5 previous tests.
Median follow-up was 7 years.
Researchers found that men who had low vs. high PSA screening intensity prior to diagnosis had more severe disease at diagnosis, as indicated by Gleason score of 8 or higher (15.3% vs. 10.7%), PSA score greater than 20 (16.3% vs. 7.2%) and metastatic disease at diagnosis (4.2% vs. 1.4%).
Greater PSA screening intensity conferred a nearly 40% reduction in odds of presenting with metastatic disease at diagnosis (OR = 0.61; 95% CI, 0.47-0.81) and 25% reduced risk for prostate cancer-specific mortality (subdistribution HR = 0.75; 95% CI, 0.59-0.95).
“Taken together, these results would suggest that PSA screening may improve cancer outcomes for young African American men, although results of this study are just one step in addressing all the racial disparities that still exist in prostate cancer,” Qiao said.
Perspective
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We know African American men are nearly 1.5 times more likely to develop prostate cancer and more than twice as likely to die of prostate cancer as white men. Despite this, young African American men aren’t fully represented in PSA studies, upon which evidence-based guidelines are based and developed. So, this really limits proper PSA screening guidance for African American men, especially for those who are aged younger than 55 years. Because we don’t have adequate screening data, there are differences in opinion as to what the guidelines should be. These data make a very strong statement to discuss screening at a younger age for African American men.
Michigan Medicine
Perspective
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This is an important study, as African American men are at a higher risk for developing prostate cancer than the average American man. At the same time, African American men, and how race affects prostate cancer screening and outcomes, have not been studied to the same extent as the general population. Studies like this one help to fill the knowledge gap that exists on how PSA screening affects outcomes for African American men.
Specifically, the findings help support the notion that PSA screening for African American men should begin at a younger age than for the general population. Although clinicians and providers who deal with prostate cancer often know that African American men are at higher risk for developing prostate cancer, most PSA screening is not performed by these clinicians and providers. The more information that can be disseminated about this at-risk group, the more likely they are to be appropriately screened.
Regarding future research, several “advanced” screening tests on the market can be used in conjunction with PSA to help determine a man’s risk for prostate cancer before a biopsy. There are also tests that can be used to estimate the aggressiveness of a newly diagnosed prostate cancer. How well these tests perform among men at high risk for prostate cancer, such as African American men, needs to be thoroughly evaluated.
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