LOS ANGELES — In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer.
Because of that disparity, a research team examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. The effort was led by the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System. Also participating were researchers from the Charlie Norwood VAMC in Augusta, GA, the VA San Diego Healthcare System and James A. Haley Veterans’ Hospital in Tampa, FL
They conducted a comprehensive literature search to identify 1,848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for the guidelines. Results were published in NEJM Evidence.
The authors point out that three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up.
“The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end,” according to the researchers. “Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men”
They added, “Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.”
The guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered, the authors advised.
- Garraway IP, Carlsson SV, Nyame YA, Vassy JL, et. Al. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM Evid. 2024 May;3(5):EVIDoa2300289. doi: 10.1056/EVIDoa2300289. Epub 2024 Apr 23. PMID: 38815168.