'Very Strong Statement' to Discuss PSA Screens With Younger AAs

Nick Mulcahy

May 19, 2021

Might more prostate-specific antigen (PSA) testing in younger African American men (40-55 years old) be a key to reducing their relatively high mortality rates from prostate cancer compared to same-aged White men?

New observational research cannot definitively say yes or no, but it does indicate that  increased intensity of PSA screening was associated with decreased risk of lethal disease.

Specifically, that increased intensity was tied to both decreased risk of metastases at time of diagnosis as well as decreased prostate-cancer specific mortality, report investigators led by Edmund M. Qiao, a fourth-year medical student at the University of California San Diego in La Jolla.

The new study, from a large national cohort of black men aged 40 to 55 years, was presented at a press briefing last week in advance of the annual meeting of the American Society of Clinical Oncology (ASCO). The meeting will be held virtually June 4-8 for the second year running.

The new findings, which will be presented in the meeting plenary session on June 6, are particularly important because Black men are poorly represented in PSA screening studies on which evidence-based prostate-cancer screening guidelines are based, commented Qiao.

This limits "proper" PSA screening guidance for Black men, especially for those younger than 55 who have not been included in any of the studies upon which PSA screening recommendations are based, he added.

The new study "makes a very strong statement to discuss screening at a younger age" with African American men, summarized briefing moderator and ASCO president Lori Pierce, MD, of the Rogel Cancer Center at the University of Michigan in Ann Arbor.

"One Step in Addressing Disparities"

The earliest recommended age to begin discussion of PSA screening is 40 years, observe the study authors. Therefore, the team identified 4726 Black men aged 40-55 years diagnosed with prostate cancer from 2004 to 2017 within the Veterans Health Administration database. The mean age was 51.8 years with a mean PSA screening rate of 53.2%.

Screening intensity was defined as percentage of years screened within the prediagnostic observation period (restricted to 5 years prior to diagnosis) and the study group was stratified into high vs low screening (mean centered).

Overall PSA screening in the cohort averaged 1.9 tests. In terms of stratification, high PSA screening consisted of an average of 3 tests (which was 61% of the cohort). Low PSA screening consisted of an average of 0.5 tests (10.6% of the cohort).

The low screening frequency group — compared with the high group — was more likely to have, at diagnosis, a Gleason score of ≥8 (18.6% vs 14.4%) as well as metastatic disease (3.7% vs 1.4%)

Overall, increased PSA screening intensity was associated with about a 40% reduction in the relative risk of metastatic disease at diagnosis and about a 25% reduction in the relative risk of prostate-cancer specific death, emphasized Qiao.

Notably, in his conclusion, Qiao said that PSA screening in young Black men was "one step in addressing racial disparities in prostate cancer." This was an acknowledgement that other variables play a part in cancer outcomes for Black men.

Those variables were recently addressed by Otis Brawley, MD, of the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and the former chief medical officer of the American Cancer Society, in a March editorial that is relevant to the new study.

Brawley pointed out that the American Medical Association recently recognized race as a social construct rather than a biological risk factor for disease. "This is progress because it will lead to a deeper understanding of socioeconomic status (SES) and racism as determinants of health," he writes.

Skin color and facial traits are used to determine the concept called race, which was developed 300 years ago to justify enslavement of Africans and is considered unscientific by anthropologists, pointed out Brawley.

"Use of race can often cloud real issues that do influence health status and outcomes," he says, listing multiple examples of those issues like diagnosis and treatment differences that result from overburdened staff at hospitals in poor neighborhoods.

In prostate cancer, specific areas of geographic origin — which reflects ancestry and not race — are "important," Brawley also comments. "Men of West African ancestry do have a higher incidence of prostate cancer," he says.

But powerful forces are also at play, he suggests. "The effects of poor SES and racism are responsible for many of the differences in health status and outcomes attributed to race," Brawley concludes.

The study was sponsored by the National Institutes of Health.

2021 American Society of Clinical Oncology annual meeting: Abstract 5004. To be presented June 6, 2021.

Nick Mulcahy is an award-winning senior journalist for Medscape, focusing on oncology, and can be reached at  nmulcahy@medscape.net  and on Twitter:  @MulcahyNick For more from Medscape Oncology, join us on Twitter and Facebook

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