Expert panel develops prostate cancer screening guidelines for Black men
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Key takeaways:
- Prostate cancer develops earlier in Black men than in other men.
- Black men should start receiving PSA testing by at least age 45.
Black men should consider early PSA screening for prostate cancer, ideally starting at age 40, according to recommendations presented at ASCO Genitourinary Cancers Symposium.
To improve survival outcomes among this high-risk population, the multidisciplinary panel of experts advised that Black men undergo screening to establish a baseline PSA value no later than age 45.
“The [Prostate Cancer Foundation] expert panel reviewed the best available evidence, which overwhelmingly supports the conclusion that Black men in the U.S. could benefit from a risk-adapted PSA screening by a reduction in the rate of metastasis from prostate cancer,” Isla P. Garraway, MD, PhD, professor and director of research in urology at the David Geffen School of Medicine at UCLA, and researchers wrote.
Background and methodology
Limited guidelines exist outlining specific recommendations for PSA-based prostate cancer screening for Black men, according to study investigators. To fill this need, Garraway and colleagues conducted a comprehensive literature search while also creating a diverse, interdisciplinary panel of experts to develop practical clinical guidelines detailing PSA screening for Black men.
Researchers searched both PubMed and Embase in April 2023, locating 287 studies utilizing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The process identified 265 relevant studies.
The interdisciplinary panel included experts from the fields of primary care, urology, medical and radiation oncology, translational science, and patient advocates.
Results, next steps
Three randomized controlled trials displayed Level 1 evidence that regular PSA screening of men aged 50 to 74 of average prostate cancer risk reduces metastasis and death at 16 to 22 years.
Available evidence for Black men considered higher than average risk for prostate cancer metastasis and death includes data regarding age to obtain baseline PSA, frequency of testing and the age when screening should end for a potential patient.
Researchers determined that PSA testing should begin in the early 40s for Black men, as modeling data suggests that prostate cancer develops 3 to 9 years earlier in Black men than in their peers.
According to researchers, lowering the age for baseline PSA testing from 50 to 55 years to 40 to 45 years, with regular screening until age 70, could reduce prostate mortality in Black men without causing a significant increase in rate of overdiagnosis.
From these findings, the panel created six recommendations:
- Black men are at high risk for prostate cancer and that the benefits of screening generally outweigh the risks;
- Black men should know that PSA is a blood test that should be considered first-line for prostate cancer screening;
- decisions regarding PSA testing depend on individual preferences and patients should seek decision-making discussions with their health care providers;
- baseline PSA testing should be done between ages 40 and 45;
- Black men over the age of 70 who have been receiving regular screening should have discussions if continued screening is necessary based on various factors; and
- Black men with family history of prostate cancer should consider annual PSA screening as early as age 40.
“Additional conclusions from the evidence review is that although more studies could elucidate the impact of PSA screening on Black men, the current evidence warrants revisiting current recommendations from early prostate cancer detection in Black men from other national guidelines groups,” the researchers wrote.
Perspective
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David M. Golombos, MD
It has been repeatedly demonstrated that Black men in the United States are among the highest risk populations for prostate cancer. Compared with their white counterparts, Black men are more likely to be diagnosed at a younger age and harbor more aggressive disease.
Beginning in the 1990s, PSA screening dramatically reduced mortality from prostate cancer across all populations. However, current guidelines differ in their recommendations about who and when to screen for prostate cancer, leading to uncertainty among patients and providers alike.
The Prostate Cancer Foundation has made a concerted and focused effort to address health disparities for Black men related to prostate cancer. Garraway and colleagues led an interdisciplinary panel of experts formed to establish practical consensus guidelines addressing PSA screening in Black men.
Six guideline statements presented at ASCO GU focused on screening in Black men. These clear, concise and plain-language guidelines are much needed and long overdue. Given the higher risk for developing prostate cancer and dying of the disease, Black men are more likely to be saved by screening. It is critically important that these patients not only be aware of their risk, but understand how they can be proactive about early detection.
Precision medicine and personalized care are core principles for the treatment of all stages of prostate cancer, and screening recommendations for susceptible populations should be no different. These guidelines hopefully go a long way in educating and empowering the Black community to make informed decisions about their health. I applaud the Prostate Cancer Foundation for continuing to lead the effort in reducing prostate cancer disparities across our country.
RWJBarnabas Health
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Garraway IP, et al. Abstract 264. Presented at: ASCO Genitourinary Cancers Symposium; Jan. 25-27, 2024; San Francisco.
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