SAN DIEGO — Black men are more likely than non-Hispanic white men to develop and die from prostate cancer, yet not much data exists that is specific to prostate-specific antigen (PSA) screening protocols by race.
A new study led by the VA Salt Lake City Healthcare Care System sought to remedy that, investigating whether the risk for prostate cancer was higher than expected among self-identified Black than white veterans based on prebiopsy PSA level. VAMCs in Ann Arbor, MI, Los Angeles and San Diego also participated in the research.
The study team estimated multivariable logistic regression models to predict the likelihood of prostate cancer diagnosis on first biopsy for 75,295 Black and 207,658 white male veterans. Used as predictors were self-identified race, age at first PSA test, prebiopsy PSA, age at first biopsy, smoking status, statin use and socioeconomic factors, and the adjusted predicted probabilities of cancer detection on first prostate biopsy from the logistic models at different PSA levels were calculated.
“After controlling for PSA and other covariates, Black veterans were 50% more likely to receive a prostate cancer diagnosis on their first prostate biopsy than white veterans (odds ratio [OR], 1.50; 95% CI, 1.47-1.53; p < .001). At a PSA level of 4.0 ng/mL, the probability of prostate cancer for a Black man was 49% compared with 39% for a White man,” according to the report in the journal Cancer. “This model indicated that Black veterans with a PSA of 4.0 ng/mL have an equivalent risk of prostate cancer as white veterans with a PSA of 13.4 ng/mL.”1
The authors said their findings indicate that, “at any given PSA level, Black men are more likely to harbor prostate cancer than white men. Prospective studies are needed to better evaluate risks and benefits of PSA screening in Black men and other high-risk populations.”
- Lee KM, Bryant AK, Lynch JA, Robison B, et. al. Association between prediagnostic PSA and prostate cancer probability in Black and non-Hispanic White men. Cancer. 2023 Nov 6. doi: 10.1002/cncr.34979. Epub ahead of print. PMID: 37927109.
