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ASCO 2021

ASCO 2021: Association of Increased Intensity of Prostate-Specific Antigen (PSA) Screening in Younger African American Men with Improved Prostate Cancer Outcomes

(UroToday.com) Current prostate-specific antigen (PSA) screening guidelines suggest an individualized approach and shared decision-making model based on patient preference and certain risk factors such as family history or race. The clinical trials that largely have guided screening recommendations notably either did not report race or did not enroll a significant proportion of self-identified African American patients, and none of these enrolled patients were younger than 55 years of age. It is well-documented that when prostate cancer is diagnosed in African American men, it is diagnosed at a higher stage, younger age, and is associated with higher rates of poor disease outcomes.


In this study, the presenters investigated the effect of PSA screening in African American men aged 40-55 to understand the implications of early screening on the clinical characteristics of the diagnosis (high-risk characteristics, metastatic disease) and on prostate cancer-specific mortality with an adjustment for lead time bias. This was accomplished using a Veterans Affairs (VA) cancer registry and related databases. A total of 4,726 African American patients were identified within this dataset.

To calculate the pre-diagnostic PSA screening rate, the authors calculated the number of PSA tests within the studied time period. The number of PSA screens was stratified using a mean-centered approach. Patients with “High” PSA screening amounts had at least 3 PSA tests prior to their diagnosis, whereas patients with “Low” PSA screening amounts had an average of 0.5 PSA tests. Patients with high PSA screening tended to be older, including at the time of diagnosis.

Higher numbers of PSA screening tests was associated with less aggressive disease at diagnosis and lower cumulative incidence of prostate cancer-specific mortality.

PSA_screening_rate.png

These findings were confirmed by multivariate regression using the parameters shown below.

PSA_screening_tests.png

The presenters concluded that their data suggest that more PSA screening may improve disease outcomes for African American men diagnosed with prostate cancer earlier than the age of 55, but note that screening will not occur in the presence of other socioeconomic barriers including access to affordable healthcare or availability of screening resources/healthcare providers.

Presented by: Edmund Qiao, BS, Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA

Written by: Alok Tewari, MD, PhD, Medical Oncologist at the Dana-Farber Cancer Institute, at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, Virtual Annual Meeting #ASCO21, June, 4-8, 2021