Black men in the United States have markedly higher rates of prostate cancer than the general population. National guidelines for prostate-specific antigen (PSA) screening do not provide clear guidance for this high-risk population. The purpose of this study is to estimate the benefit and harm of intensified PSA screening in Black men.
Two microsimulation models of prostate cancer calibrated to incidence from the Surveillance, Epidemiology, and End Results program among Black men project the impact of different screening strategies (varying screening intervals, starting and stopping ages, and biopsy utilization following an abnormal PSA) on disease-specific mortality and overdiagnosis. Each strategy induces a mean lead time (MLT) for detected cases. A longer MLT reduces mortality according to estimates combining the US and European prostate cancer screening trials but increases overdiagnosis.
Under historical population screening, Black men had similar MLT to men of all races, and similar mortality reduction (range between models = 21-24% vs. 20-24%) but a higher frequency of overdiagnosis (75-86 vs. 58-60 per 1000 men). Screening Black men aged 40-84 years annually would increase both mortality reduction (29-31%) and overdiagnosis (112-129 per 1000). Restricting screening to age 45-69 years would still achieve substantial mortality reduction (26-29%) with lower overdiagnosis (51-61 per 1000). Increasing biopsy utilization to 100% of abnormal tests would further reduce mortality but substantially increase overdiagnosis.
Annual screening in Black men is expected to reduce mortality more than that estimated under historical screening. Limiting screening to men below 70 years is expected to help to reduce overdiagnosis.
Journal of the National Cancer Institute. 2021 May 08 [Epub ahead of print]
Yaw A Nyame, Roman Gulati, Eveline A M Heijnsdijk, Alex Tsodikov, Angela B Mariotto, John L Gore, Ruth Etzioni
Department of Urology, University of Washington Medical Center, Seattle, WA, USA., Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands., School of Public Health, University of Michigan, Ann Arbor, MI, USA., Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.