Increased PSA Screening Associated With Lower Risk of Advanced Prostate Cancer at Diagnosis, Mortality in Younger African American Patients

Conducting frequent prostate-specific antigen (PSA) screenings was found to lower the risk of metastasis at the time of diagnosis and lower mortality risk from prostate cancer among younger African American men, according to study data to be presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

These results support the importance of talking with patients about the advantages and disadvantages of prostate cancer screening in order to individualize patient care in an approach based on the needs of each patient during treatment.

“This study lends weight to the importance of discussions between doctors and individual patients about the risks and benefits of PSA screening. There is not a one-size-fits all approach, particularly for patients at higher risk of prostate cancer, such as African American men. This observational study shows us that screening may be useful even in younger African Americans,” said ASCO president Lori J. Pierce, MD, FASTRO, FASCO, in a press release.

During the study, investigators assessed data from 4726 African American patients, aged 40 to 55 years, who were diagnosed with prostate cancer between 2004 and 2017, and are listed in the Veterans Health Administration database.

Based on their analysis, the investigators observed that the pre-diagnostic PSA screening intensity was linked to a significantly decreased risk of advanced and metastatic disease at diagnosis among young African American men.

Specifically, they observed a link between increased PSA screening intensity and an approximately 40% reduced risk of metastatic prostate cancer at the time of diagnosis, as well as an approximately 25% reduced mortality risk among patients.

For the purposes of the study, the investigators noted that they defined screening intensity as the percentage of years screened within the pre-diagnostic observation period, which would include up to 5 years before the time of diagnosis.

Additionally, the investigators observed that increased primary care utilization was similarly associated with decreased risk of advanced disease and death, showing how PSA screening along with close primary care utilization has the potential to significantly improve prostate cancer outcomes among younger African American men.

These results are notable in light of prior data that have shown African American patients are approximately 1.5 times more likely to develop prostate cancer and over 2 times more at risk of mortality from prostate cancer than white patients. At time of diagnosis, African American patients are also more likely to present with lethal prostate cancer than white patients.

Due to the high risk of prostate cancer disease development and mortality among African American patients, the investigators looked specifically at the impact of PSA screening on prostate cancer outcomes among a younger population of African American patients.

Historically, PSA studies that have been conducted on this subject in the United States have not adequately included African American patients within the study population. This lack of adequate representation in studies has caused limitations in the ability to provide proper PSA screening guidance for African American patients, and especially for an American patients younger than 55 years of age.

The screening guidelines currently used by the US Preventive Services Task Force have noted that PSA screenings can begin to be conducted at 55 years of age for all patients. However, other medical societies, such as the National Comprehensive Cancer Network and American Urological Association, have noted that there is benefit for African American patients to start PSA screening as early as 40 years of age.

“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,” said lead author Edmund M. Qiao, BS, of the University of California San Diego, in the press release. “The findings also bring us closer to addressing racial disparities that exist in prostate cancer.”

REFERENCE

Increased PSA Screening Linked to Lower Risk of Advanced Prostate Cancer at Diagnosis and Death From the Disease in Younger African American Patients. Alexandria, VA: 2021 American Society of Clinical Oncology Annual Meeting; May 19, 2021. https://www.asco.org/about-asco/press-center/news-releases/increased-psa-screening-linked-lower-risk-advanced-prostate?cid=DM7637&bid=80018089. Accessed June 2, 2021.