1. Samson, Kurt

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More frequent prostate cancer screening has reduced the risk profile of younger African-American males diagnosed with the disease, according to a data presented at the 2021 ASCO Annual Meeting. The observational study found that younger African-American men undergoing frequent prostate cancer screening had lower risk of metastasis at the time of prostate cancer diagnosis, as well as reduced rates of fatal disease (Abstract 5004).

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The researchers found that PSA screening was associated with about a 25 percent reduction in prostate cancer-specific mortality. Confounding factors included primary care visit rate, age at diagnosis, year of diagnosis, Charlson comorbidity score, employment, marital status, college education, and income, said lead author Edmund M. Qiao, BS, a fourth-year medical school student at the University of California San Diego.


"The findings reinforce the importance of early PSA screenings in African-American men, as our research suggests that earlier PSA screening may improve their prostate cancer outcomes. They also bring us closer to addressing racial disparities that exist in prostate cancer," he said.


Study Details

In the population-based study, researchers identified 4,726 African-American men with prostate cancer from the Veterans Health Administration database ages of 40-55 years and diagnosed with the disease between 2004 and 2017. The mean patient age was 51.8 years.


The team examined the association of pre-diagnostic PSA screening intensity-defined as the percentage of years screened in the period before diagnosis-with disease outcomes. The pre-diagnosis period included up to 5 years prior to diagnosis.


"We found that PSA screening was associated with a decreased risk of Gleason score >=8, PSA >20, and metastatic disease at diagnosis, as well as prostate cancer-specific mortality. Taken together, these results would suggest that [increased] PSA screening may improve cancer outcomes for young African-American men. Although the results of this study are just one step in addressing all of the other racial disparities that still exist in prostate cancer."


The mean number of previous PSA screening tests was 1.9. The high PSA screening group had received an average of three prior tests while the "low PSA screening" cohort had received on average 0.5 prior tests. All data showed the high PSA screening group had lower severity.


Those with Gleason scores >=8 and PSA >20 at diagnosis were 15.3 percent versus 10.7 percent and 16.3 percent versus 7.2 percent in the lower versus higher screening groups, respectively. Further, the rate of metastatic disease at diagnosis was 4.2 percent versus 1.4 percent, respectively, translating to a 39 percent risk reduction.


Qiao and his colleagues also found that pre-diagnostic PSA screening intensity was associated with a nearly 40 percent reduced risk of metastatic prostate cancer at the time of diagnosis and a nearly 25 percent decreased risk of death from the disease in younger African-American patients.


The findings also 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 in younger African-American men.


Importance of Screening

These new findings are significant given that African-American 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, national data show. They are also more likely to present with lethal prostate cancer than White counterparts.


African-American patients have been poorly represented in PSA studies from which evidence-based guidelines have been developed in the past, the researchers noted, resulting in poorer PSA screening guidance for younger men, especially for those younger than 55 years of age.


"African-American men have the highest mortality rate for prostate cancer; however, the data for PSA screening includes very few African-American men and no young African-American men between the ages of 40 and 55," they noted. "This has led to discordant PSA screening recommendations for these patients and, as a result, young African-American men are an at-risk group that needs additional research to help guide their clinicians and themselves when deciding when to start PSA screening."


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.


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 African-American patients may consider starting PSA screening as early as age 40.


Going forward, the investigators are planning on performing a similar analysis using larger population-level data to capture patients who are at average risk of prostate cancer, and to increase the number of patients younger than 50 years.


Commenting on the study, ASCO President Lori J. Pierce, MD, FASTRO, FASCO, said the study highlights the need for greater awareness and discussion by primary care doctors and younger African-American patients.


"This study lends weight to the importance of discussions between doctors and individual patients about the risks and benefits of PSA screening," she said. "There is not a one-size-fits-all approach, particularly for patients at higher risk of prostate cancer, such as African-American men.


"We know African-American men are nearly one-and-a-half times more likely to develop prostate cancer and more than twice as likely to die from prostate cancer as White patients," Pierce noted. "And despite this, young African-American men are poorly represented in PSA studies from which evidence-based guidelines are developed.


"This really limits proper PSA guidance screening guidance for African-American patients, especially for those who are younger than 55. And so, because we don't have adequate screening data, there are differences in opinion as to what the guidelines should be. And so, this abstract makes a very strong statement to discuss screening at a younger age in African-American men."


Kurt Samson is a contributing writer.