Annual PSA screening may be especially important for Black men
PSA screening appeared associated with lower prostate cancer-specific mortality among both black men and non-Hispanic white men, according to study results published in JAMA Oncology.
However, annual PSA screening — compared with less frequent screening — only reduced prostate cancer-specific mortality among Black men. This suggests annual screening may be most important for this particular group, researchers wrote.
Rationale and methods
Black men have higher prostate cancer incidence and mortality than white men; however, they have been underrepresented in clinical trials designed to evaluate the potential benefits of PSA screening.
Therefore, data are lacking to guide screening recommendations for this patient population, according to study background.
Michael V. Sherer, MD, radiation oncologist in the department of radiation medicine and applied sciences at University of California, San Diego, and colleagues conducted a retrospective cohort study to assess whether PSA screening is associated with reduced risk for prostate cancer-specific mortality among Black men compared with white men.
Researchers used the U.S. Veterans Health Administration Informatics and Computing Infrastructure to obtain data on 45,834 men (mean age, 62.7 years; 69% white; 31% Black) diagnosed with intermediate-, high- or very high-risk prostate cancer between Jan. 1, 2004, and Dec. 31, 2017.
Researchers used Fine-Gray regression analysis to assess the association between PSA screening rate — defined as the percentage of years in which men underwent PSA screening during the 5 years before prostate cancer diagnosis — and prostate cancer-specific mortality.
In a subset analysis, researchers assessed prostate cancer-specific mortality risk among those with no prior PSA screening, less than annual screening or annual screening within the 5 years before diagnosis.
The risk for prostate cancer-specific mortality among Black and white men served as the primary outcome.
Key findings
Researchers observed an association between PSA screening and reduced risk for prostate cancer specific mortality among Black men (subdistribution HR [sHR] = 0.56; 95% CI, 0.41-0.76) and white men (sHR = 0.58; 95% CI, 0.46-0.75).
However, results of the subset analysis that compared annual screening vs. less than annual screening showed only Black men who underwent annual screening exhibited reduced risk for prostate cancer-specific mortality (sHR = 0.65; 95% CI, 0.46-0.92).
Implications
Study strengths included the large, racially diverse cohort and the availability of laboratory PSA values, researchers wrote. Investigators acknowledged study limitations, including the use of retrospective data and the potential difficulties of generalizing results between the U.S. Veterans Health Administration population and the broader US population.
Still, the findings suggest that annual PSA screening may be particularly important for Black men, according to investigators.
“Further research is needed to identify appropriate populations and protocols to maximize the benefits of PSA screening,” they wrote.
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