Black Patients May Be Adversely Affected by Less PSA Screening
Black patients who met age criteria for PSA screening were 28% more likely to die of their prostate cancer than patients ineligible for screening.
The potential impact of the 2012 US Preventative Services Task Force (USPSTF) recommendations against routine PSA screening has been uncertain. Researchers presenting at the 2017 Genitourinary Cancers Symposium in Orlando suggest that black men may have higher risks of poor prostate cancer (PCa) outcomes than other races – and particularly those eligible for PSA screening.
Brandon Mahal, MD, of Harvard Radiation Oncology Program in Boston, and colleagues compared the risks of PCa metastasis and mortality by black and non-black race. Using the Surveillance, Epidemiology, and End Results (SEER) database, they investigated outcomes for 390,259 men diagnosed with PCa 2004 to 2011, prior to the USPSTF recommendations.
Results showed that black men were 65% more likely to be diagnosed with metastatic PCa than non-black men. In addition, their risks of dying from PCa were 36% higher. The racial disparity held after adjustments for clinical factors including Gleason score, cancer stage, treatment modality, and age at diagnosis, as well as socioeconomic factors including education and income.
Moreover, the investigators found significant interactions between race and PSA screening eligibility. Black patients who met the age criteria for PSA screening, 55 to 69 years, had higher odds of metastatic disease (76% vs 55%) and PCa mortality (53% vs 25%) than ineligible patients.
“Racial disparities in prostate cancer outcomes among black men are much worse in PSA-screening eligible populations,” Brandon Mahal, MD, of Harvard Radiation Oncology Program in Boston, told Renal & Urology News. “Black men of screening age may be disproportionately impacted by recommendations to end PSA screening. It is likely that the number needed to screen and treat to save one black man's life is lower than the numbers reported in PSA screening trials.”
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1. Mahal BAV, Chen YW, Muralidhar V, et al. Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States. Data presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida, February 16-18, 2017. Poster Session A (Board #B5). Abstract: 18.