In a study reported in JAMA Oncology, Sherer et al found that prostate-specific antigen (PSA) screening was associated with reduced prostate cancer mortality among both non-Hispanic Black and non-Hispanic White U.S. veterans who developed prostate cancer. Annual vs some screening was associated with significantly reduced mortality among Black men, but not White men.
As stated by the investigators, “Black men have higher prostate cancer incidence and mortality than non-Hispanic White men. However, Black men have been underrepresented in clinical trials of PSA screening; thus, there is a lack of data to guide screening recommendations for this population.”
Study Details
The retrospective cohort study used data from the U.S. Veterans Health Administration Informatics and Computing Infrastructure for men aged 55 to 69 years who self-identified as non-Hispanic Black or non-Hispanic White and were diagnosed with intermediate-, high-, or very high–risk prostate cancer between January 2004 and December 2017. PSA screening rate was defined as the number of years in which PSA screening was performed in each individual during the 5 years prior to diagnosis.
Key Findings
The study population consisted of 14,310 Black men and 31,524 White men. Median follow-up was 77 months (interquartile range = 41–111 months). At diagnosis, Black men were younger (mean age = 61.8 vs 63.1 years, P = .001) and had higher PSA levels (mean = 15.1 vs 13.0 ng/mL, P = .001). Overall, 2,465 men (5.4%) died from prostate cancer.
For Black men vs White men, 29.6% vs 28.6% had no PSA screening, 61.0% vs 61.5% had some screening (1–4 screenings in 13%–17% vs 14%–17%), and 9.4% vs 9.9% had annual screening during the 5 years preceding diagnosis.
On multivariate analysis, PSA screening rate as a continuous variable was associated with a significant reduction in risk of prostate cancer mortality among both Black men (subdistribution hazard ratio [HR] = 0.56, 95% confidence interval [CI] = 0.41–0.76, P = .001) and White men (subdistribution HR = 0.58, 95% CI = 0.46–0.75, P = .001).
At 120 months of follow-up, the estimated cumulative incidence of prostate cancer mortality was 4.7% (95% CI = 2.9%–6.4%) among Black men receiving annual screening vs 7.3% (95% CI = 6.5%–8.0%) among those receiving some screening (absolute difference = 2.6%). The corresponding figures for White men were 5.9% (95% CI = 4.7%–7.0%) vs 6.9% (95% CI = 6.4%–7.3%; absolute difference = 1.0%). On multivariate analysis, annual vs some screening was associated with a significant reduction in risk for prostate cancer mortality among Black men (subdistribution HR = 0.65, 95% CI = 0.46–0.92, P = .02) but not among White men (subdistribution HR = 0.91, 95% CI = 0.74–1.11, P = .35).
The investigators concluded, “In this cohort study, PSA screening was associated with reduced risk of prostate cancer–specific mortality among non-Hispanic Black men and non-Hispanic White men. Annual screening was associated with reduced risk of prostate cancer–specific mortality among Black men but not among White men, suggesting that annual screening may be particularly important for Black men. Further research is needed to identify appropriate populations and protocols to maximize the benefits of PSA screening.”
Brent S. Rose, MD, of the Department of Radiation Medicine and Applied Sciences, University of California, San Diego, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
