Previous research has shown higher rates of prostate cancer and prostate cancer deaths among Black than White men. Now a new study finds that PSA screening may decrease the risk of prostate cancer death among both Black and White men. Annual vs less frequent screening particularly benefits the Black population, according to investigators.
In the retrospective study of US veterans with prostate cancer, a higher PSA screening rate in the 5 years before diagnosis (analyzed as a continuous variable) was significantly associated with a similar 44% and 42% reduced risk of prostate cancer-specific death in Black and White men, respectively, Brent S. Rose, MD, of the University of California, San Diego, and colleagues reported in JAMA Oncology. Annual screening (vs some screening) was significantly associated with a 35% lower risk of prostate cancer-specific mortality among Black men, but not among White men. At 120 months, prostate cancer death among Black men receiving annual PSA screening was 4.7% compared with 7.3% among Black men receiving only some screening.
The study included 45,834 US veterans, of whom 14,310 (31%) were non-Hispanic Black and 31,524 (69%) were non-Hispanic White. Included men were aged 55 to 69 years at diagnosis. The Black veterans had significantly higher PSA levels at diagnosis than White veterans: 15.1 vs 13.0 ng/mL, respectively.
The findings corroborate results from another recent study of younger Black veterans aged 40-55 years diagnosed with prostate cancer by Dr Rose and his colleagues. In that study, published in the Journal of the National Cancer Institute, PSA screening vs no screening was significantly associated with 44% decreased odds of PSA levels higher than 20 ng/mL, 22% decreased odds of a Gleason score of 8 or higher, 50% decreased odds of metastatic disease at diagnosis, and 48% decreased odds of prostate cancer-specific mortality.
According to Dr Rose’s team, “Black men in particular may benefit from more intensive screening protocols. These results may be biologically plausible because a shorter screening interval may be valuable for detecting aggressive disease, which is more common in Black men.”
A model-based study recently published in the New England Journal of Medicine also found strong support for prostate-specific antigen screening particularly in Black men.
Sherer MV, Qiao EM, Kotha NV, Qian AS, Rose BS. Association between prostate-specific antigen screening and prostate cancer mortality among non-hispanic black and non-hispanic white US veterans. JAMA Oncol. Published online August 4, 2022. doi:10.1001/jamaoncol.2022.2970
Qiao EM, Lynch JA, Lee KM, et al. Evaluating prostate-specific antigen screening for young African American men with cancer. J Natl Canc Inst 114(4):592–599. doi:10.1093/jnci/djab221