Prostate Cancer Foundation's Guidelines for Black Men in the US - Isla Garraway

February 20, 2024

Sam Washington and Isla Garraway discuss the Prostate Cancer Foundation's new screening guidelines for prostate cancer in Black men. Dr. Garraway highlights the guidelines' development process, involving a diverse panel from various disciplines, including patient advocates, to address the unique risks Black men face regarding prostate cancer. These guidelines aim to inform Black men about their increased risk and guide them in making informed decisions on screening in collaboration with their healthcare providers. Dr. Garraway emphasizes the significance of early and regular screening starting at age 40, tailored by baseline test results and continuous dialogue with healthcare professionals, hoping these guidelines will contribute to reducing disparities in prostate cancer outcomes.


Isla P. Garraway, MD, PhD, Associate Professor and Director of Research, Department of Urology, UCLA School of Medicine, UCLA Health

Samuel L. Washington III, MD, MAS, Urologist, Goldberg-Benioff Endowed Professorship in Cancer Biology, University of Southern California, San Francisco, CA

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Sam Washington: Here we are at ASCO GU 2024. Thank you, Dr. Isla Garraway, for taking the time to speak with us about the Prostate Cancer Foundation's screening guidelines for prostate cancer in Black men in the United States. Can you tell us a little bit about your roles at UCLA?

Isla Garraway: Oh, yes, sure. So, I am a professor of Urology at UCLA and the director of Research in the Department of Urology, and I'm also an attending physician at the VA Greater Los Angeles.

Sam Washington: I wanted to go over the Prostate Cancer Foundation screening guidelines for prostate cancer in Black men in the United States.

Isla Garraway: It's very exciting to talk about the work of this wonderful panel of investigators and stakeholders that put together this set of guidelines that we're presenting for the first time at the GU ASCO meeting.

Sam Washington: It's an amazing effort and a step in the right direction to focus efforts on this population where we know there's been a disparity.

Isla Garraway: Well, we certainly hope that it's considered a step in the right direction because I think there's a lot of controversy surrounding the guidelines and which guidelines to follow in terms of our societal guidelines, our national guidelines. There are many that are put out by different agencies and not always totally consistent. And also, there's just a little bit of controversy surrounding whether or not we even should screen men for prostate cancer since it's not always totally clear that there is a benefit. And there's also, of course, harms involved in screening if we're not screening the right person at the right time in their life, so we really wanted to address what are practical guidelines that patients and their families can use to just be informed about what they should be thinking about, how they will figure out their individual risk. We know that Black men are a high-risk population, but how do you basically translate that into my own individual risk as a person? So hopefully, that's doing that, and we'll help provide information for them to make an informed decision about whether or not prostate screening is right for them.

Sam Washington: Now, to pull all this together to generate these guidelines and pull all of that data together, could you speak a little bit about the effort, the time, everything that went into that?

Isla Garaway: Oh, absolutely. Well, first of all, what the Prostate Cancer Foundation did was pull together, through their really broad network of experts, just key stakeholders from multiple disciplines. So we had urologists like me, representative, which I'm so proud and happy to have helped with this work, and then we had medical oncologists and radiation oncologists, basic scientists, and we had patient advocates informing the committee as well. So there's a lot of input from a lot of different types of people with a broad range of experiences to really pull together the data that already exists. So looking at published reports and really critically looking at that data and then saying, "Hey, what's the evidence here? What do we have specifically to tell us and guide us about prostate cancer screening in Black men?"

And so, from that big synthesis of data and integration of data, we were able to generate key questions from just very basic questions like, "Should Black men be screened for prostate cancer?" To more specific questions like, at what age should screening start? How frequently should that screening occur? And then, based on those questions, we were able to come up with our guidelines based on the consensus of all the stakeholders informed by patient advocates and expert opinion.

Sam Washington: Well, I highly recommend everyone read those guidelines and go through them. What do you think are the key takeaways that people should take from this interview in addition to reading the guidelines?

Isla Garaway: Well, the key information for Black men specifically is just really understanding that this population is one of several high-risk populations, but basically, Black men are significantly affected year over year with prostate cancer with a really significant increase in incidence compared to any other racial ethnic population. And not only is their risk of incidence higher, the risk of progressive disease and death from prostate cancer is the highest among any race ethnic group. So it's important just to be educated about that, that they're in a high-risk category so that then they can address whether or not screening is something that they want to do. Screening is a decision that's made between the patient and their healthcare provider, so it's important that the patient knows about this to have this conversation with their healthcare provider. So the take-home message is really to make sure you have that conversation with your healthcare provider about if screening is right for you and when you should start, and when you should maybe stop screening even.

Sam Washington: So once these come out, what do you think are the next steps, building on the information, knowledge, effort, and everything going into this and disseminating it?

Isla Garaway: Oh, absolutely. Well, I think prostate cancer screening is maybe one of several different factors that can help close the gap that we see in terms of these disparities. So what we hopefully want to do is just see the implementation of these guidelines, at least at the level of making sure that Black men know that they should start screening or consider screening as early as age 40, and that they should consider regular screening. So maybe get a baseline test at age 40 and then screen every one to two years based on the results of that baseline test. But again, there has to be an interaction with the healthcare provider to help educate about what the test means and what the next steps will be once they have that testing.

Sam Washington: It's an exciting space, exciting road forward. I'm glad there are guidelines to help get us down that path. Thank you so much for taking the time to chat with us about all of this.

Isla Garaway: Yes, it's great to be here, and thank you.

Sam Washington: Thank you.

Isla Garaway: All right.

Sam Washington: All right.