Increased PSA Screening Linked to Lower Risk of Advanced Prostate Cancer at Diagnosis and Death From the Disease in Younger African American Patients

ASCO Perspective

“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.

San Francisco, CA (UroToday.com) -- Younger African American men undergoing frequent prostate cancer screening appear to have both a lower risk of metastasis at the time of prostate cancer diagnosis and of fatal disease, according to data from an observational study to be presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

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.

Study at a Glance

Focus: The impact of PSA screening on prostate cancer outcomes for younger African American patients.

Population: 4,726 African American patients from the Veterans Health Administration database age 40-55 years and diagnosed with prostate cancer from 2004 to 2017.

Findings: Increased PSA screening intensity was associated with a nearly 40% reduced risk of metastatic disease at the time of diagnosis and a nearly 25% decreased risk of death due to prostate cancer in younger African American patients.

Significance: The findings support the hypothesis that PSA screening and early prostate cancer detection may improve outcomes in younger African American patients. The study results are one step toward addressing racial healthcare disparities in the care of patients with prostate cancer.

Key Findings

The researchers found that pre-diagnostic Prostate-Specific Antigen (PSA) screening intensity was associated with significantly lower odds of advanced and metastatic disease at diagnosis for young African American men. Specifically, increased PSA screening intensity was associated with a nearly 40% reduced risk of metastatic prostate cancer at the time of diagnosis and a nearly 25% decreased risk of death from the disease in younger African American patients. Screening intensity was defined as the percentage of years screened within the pre-diagnostic observation period, including up to five years prior to diagnosis.

Also of note, the study 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.

Pre-diagnostic PSA screening intensity was associated with significantly lower odds of advanced and metastatic disease at diagnosis for young African American men.

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.1,2 In addition, African American patients are also more likely to present with lethal prostate cancer than white patients.

Historically, African American patients have been poorly represented in PSA studies from which evidence-based guidelines were developed, said the researchers. This limits proper PSA screening guidance for African American patients, especially for those younger than 55.3

Current screening guidelines from the U.S. Preventive Services Task Force state PSA screening may begin at age 55. 3 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 40.4,5

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

In this large population-based study, researchers identified 4,726 African American patients with prostate cancer from the Veterans Health Administration database. All were age 40-55 years and diagnosed with the disease between 2004 and 2017.

The researchers 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 five years prior to diagnosis. Multivariable logistic regression was used to assess the influence of PSA screening intensity on metastatic disease at diagnosis.

Next Steps

The researchers plan to perform a similar analysis using larger population-level data to capture patients who are at average risk of prostate cancer and increase the number of patients younger than 50 years in their research.

  1. CDC, Summary Health Statistics: National Health Interview Survey: 2018. Table A-3a. http://www.cdc.gov/nchs/nhis/shs/tables.htm, 2020.
  2. National Cancer Institute, Cancer Stat Facts: Prostate Cancer, https://seer.cancer.gov/statfacts/html/prost.html, 2020.
  3. U.S. Preventive Services Task Force, Final Recommendation Statement: Prostate Cancer: Screening, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostatecancer-screening, 2018.
  4. Prostate Cancer: Early Detection Guideline - American Urological Association. Accessed March 30, 2021. https://www.auanet.org/guidelines/prostate-cancer-early-detection-guideline
  5. Andriole G, Bahnson RR, Carlsson S, et al. NCCN Guidelines Version 2.2019 Prostate Cancer Early Detection.; 2019.    
Source: "Increased PSA Screening Linked To Lower Risk Of Advanced Prostate Cancer At Diagnosis And Death From The Disease In Younger African American Patients". 2021. ASCO. 
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