Increased Screening Associated with Improved Outcomes in Younger Black Patients with Prostate Cancer

Jason Broderick

The study results lend strength to discuss prostate cancer screening in younger Black men, according to an expert.

Data from a recent study demonstrated that increased prostate-specific antigen (PSA) screening was associated with improved outcomes in younger Black patients with prostate cancer.

Among this patient population, an increased frequency of PSA screening was linked to a nearly 25% reduction in prostate cancer–specific mortality and an approximately 40% lower risk of having metastatic disease at the time of a prostate cancer diagnosis.

“We found that PSA screening was associated with a decreased risk of … metastatic disease at diagnosis, as well as prostate cancer–specific mortality. Taken together, these results would suggest that [increased] PSA screening may improve cancer outcomes for young African American men,” said lead study author Edmund M. Qiao, of the University of California San Diego, during a presentation of the data on a news briefing held ahead of the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

A blood test and PSA screening may indicate the presence of prostate cancer. However, other conditions, such as an inflamed prostate, can increase PSA levels, which is why there is conflicting advice involving screening.

Overall, the study included 4,726 Black men (mean age, 51.8 years) diagnosed with prostate cancer. The “high PSA screening” group had received an average of three prior screening tests and the “low PSA screening” group had received an average of 0.5 prior screening tests.

Regarding disease severity at diagnosis, all important metrics showed that the high PSA screening group had lower severity. The rate of metastatic disease at diagnosis was 4.2% versus 1.4%, respectively, translating to a 39% risk reduction.

“In our statistical model, controlling for the confounders, we found that PSA screening was associated with about a 25% reduction in prostate cancer–specific mortality,” noted Qiao. The confounding factors controlled for in the statistical model included primary care visit rate, age at diagnosis, year of diagnosis, employment, marital status, college education and income.

Black men have the highest mortality rate in prostate cancer, Qiao noted. Prior to this research, he highlighted, there has been limited data on PSA screening in this patient population.

“The data for PSA screening includes very few African American men (in general) and no young African American men between the ages of 40 and 55,” he said. “This has led to discordant PSA screening recommendations for these patients and as a result, young African American men are an at-risk group that needs additional research to help guide their clinicians and themselves when deciding when to start PSA screening.”

In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a grade D recommendation against the use of PSA screening in the general U.S. population, regardless of age. The current USPSTF PSA screening policy is slightly changed, with a grade C recommendation for men aged 55 to 69 years, meaning in this population, an individual decision on screening should be made based on a physician-clinician discussion of the potential benefits and risks.

While the USPSTF acknowledges that family history and Black race are two of the most significant risk factors for developing prostate cancer, the panel maintains that there is insufficient evidence to issue individualized screening recommendations in any age group based on those factors.

“We know African American men are nearly one-and-a-half times more likely to develop prostate cancer and more than twice as likely to die from prostate cancer as White patients,” ASCO President Dr. Lori J. Pierce said during the news briefing. “And despite this, young African American men are poorly represented in PSA studies from which evidence-based guidelines are developed. So, this really limits proper PSA guidance screening guidance for African American patients, especially for those who are younger than 55. And so, because we don't have adequate screening data, there are differences in opinion as to what the guidelines should be. And so, this abstract makes a very strong statement to discuss screening at a younger age in African American men.”

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