Black men in the United States are more likely to develop prostate cancer than White men, and after diagnosis, they’re more likely to have advanced disease and to die of the disease than White men. Although it would seem that earlier prostate‐specific antigen (PSA) screening would reduce the risk of fatal prostate cancer in Black men, new research indicates that at any given PSA level, Black men are more likely to harbor prostate cancer than White men, indicating that they may face an increased risk of prostate cancer than White men at lower PSA levels. These findings were published by Lee et al in the journal Cancer.
Study Methods and Findings
For the study, researchers used models to predict the likelihood of a prostate cancer diagnosis from a first biopsy for 75,295 Black and 207,658 White male veterans receiving care from the U.S. Department of Veterans Affairs (VA). Prostate cancer was detected in the first prostate biopsy in 55% of Black men and in 43% of White men. After taking various competing factors into account, Black veterans were 50% more likely to receive a prostate cancer diagnosis based on their first prostate biopsy than White veterans.
Also, Black men with a prebiopsy PSA of 4.0 ng/mL had a 49% risk of prostate cancer detected during their biopsy, compared with a 39% risk for White men with the same PSA level. The investigators’ model indicated that Black veterans with a PSA of 4.0 ng/mL had an equivalent risk of prostate cancer as White veterans with a PSA of 13.4 ng/mL.
“These findings suggest that to reduce health disparities for veterans in the prevention of prostate cancer, clinicians should consider an individual’s risk for prostate cancer, including factors such as race and age. Clinicians may consider earlier screening for populations at greater than average risk, which includes Black men,” said first author Kyung Min Lee, PhD, of the VA Informatics and Computing Infrastructure, located within the VA Salt Lake City Health Care System.
Dr. Lee added that prospective studies are needed to evaluate the risks and benefits of lower PSA biopsy thresholds informed by patient race and genetic risk scores. “The VA Office of Research & Development has recently initiated the ProGRESS clinical trial—The Prostate Cancer, Genetic Risk, and Equitable Screening Study—to evaluate these questions,” he said.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
