LA JOLLA, CA — Younger African-American men are at high risk of prostate cancer but tend to be underrepresented in clinical trials related to prostate-specific antigen (PSA) levels, according to a new study.
That limits proper evidence-based guidance, according to researchers from the VA San Diego Health Care System who focused on the effect of PSA screening, as well as primary care provider utilization, on prostate cancer outcomes for that cohort.
Included in the study published in the Journal of the National Cancer Institute were 4,726 African-American men aged 40-55, who were diagnosed with prostate cancer between 2004-2017 at the VHA. Inverse probability of treatment weighted propensity scores were used to assess PSA screening impact on PSA >20, Gleason score ≥8 and metastatic disease at diagnosis.1
Of the patients—who had a median age of 51.8 and had a median of 84 months of follow-up—22.4% had no PSA screening prior to diagnosis. Researchers reported that, compared to no screening, PSA screening was associated with statistically significantly reduced odds of:
- PSA > 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49-0.63, P <0.001),
- Gleason score ≥8 (OR = 0.78, 95% CI = 0.69-0.88, P <0.001), and
- lower rates of metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39-0.64, P < 0.001), and
- decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36-0.76, P < 0.001).
The authors noted that similar effects were seen with primary care provider visits.
“Among young African-American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA >20, Gleason score ≥8, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM,” the study concluded. “However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.”
- Qiao EM, Lynch JA, Lee KM, Kotha NV, et. al. Evaluating Prostate-Specific Antigen Screening for Young African American Men with Cancer. J Natl Cancer Inst. 2021 Dec 10:djab221. doi: 10.1093/jnci/djab221. Epub ahead of print. PMID: 34893859.
