Younger Black men undergoing frequent prostate-specific antigen (PSA) screening appear to have both a lower risk of metastasis at the time of prostate cancer diagnosis and of fatal disease, according to data from an observational study by Qiao et al presented at a presscast in advance of the 2021 ASCO Annual Meeting (Abstract 5004).

The findings add weight to the importance of discussing the pros and cons of prostate cancer screening with patients to develop a tailored approach to prostate care.

Study Details

In this large population-based study, researchers identified 4,726 Black patients with prostate cancer from the Veterans Health Administration database. All were aged 40 to 55 and were diagnosed with the disease between 2004 and 2017.

The researchers examined the association of prediagnostic PSA screening intensity—defined as the percentage of years screened in the period before diagnosis—with disease outcomes. The prediagnosis period included up to 5 years prior to diagnosis. Multivariable logistic regression was used to assess the influence of PSA screening intensity on metastatic disease at diagnosis.

Results From Analysis of Prediagnostic PSA Screening Intensity

The researchers found that prediagnostic PSA screening intensity was associated with significantly lower odds of advanced and metastatic disease at diagnosis for young Black men. Specifically, increased PSA screening intensity was associated with a nearly 40% reduced risk of metastatic prostate cancer at the time of diagnosis and a nearly 25% decreased risk of death from the disease in younger Black patients.

Also of note, the study showed that higher primary care utilization offered similar effects on risk of advanced disease and death, demonstrating that PSA screening in conjunction with close primary care utilization may improve prostate cancer outcomes this population.

These new findings are significant, given that Black patients are nearly 1.5 times more likely to develop prostate cancer and more than twice as likely to die from prostate cancer as White patients.  In addition, Black patients are also more likely to present with lethal prostate cancer than White patients.

Historically, Black patients have been poorly represented in PSA studies from which evidence-based guidelines were developed, said the researchers. This limits proper PSA screening guidance for Black patients, especially for those younger than age 55. Current screening guidelines from the U.S. Preventive Services Task Force state PSA screening may begin at age 55. Other medical societies—including the National Comprehensive Cancer Network and American Urological Association—state that Black patients may consider starting PSA screening as early as age 40.

“The findings reinforce the importance of early PSA screenings in [Black] men, as our research suggests that earlier PSA screening may improve their prostate cancer outcomes. The findings also bring us closer to addressing racial disparities that exist in prostate cancer,” said lead author Edmund M. Qiao, BS, of the University of California, San Diego.

The researchers plan to perform a similar analysis using larger population-level data to capture patients who are at average risk of prostate cancer and increase the number of patients younger than 50 in their research.

Lori J. Pierce, MD, FASTRO, FASCO

Perspective

“This study lends weight to the importance of discussions between doctors and individual patients about the risks and benefits of PSA screening. There is not a one-size-fits all approach, particularly for patients at higher risk of prostate cancer, such as African American men. This observational study shows us that screening may be useful even in younger African Americans,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO.

Disclosure: For full disclosures of the study authors, visit coi.asco.org.