Prostate-specific antigen (PSA) testing in younger African American men (40-55 years) would be key to reducing their mortality rates prostate cancer compared to white men of the same age?
New observational research cannot definitively say yes or no, but they do indicate that increased intensity of PSA screening was associated with a lower risk of lethal disease.
Specifically, the increase in intensity was related to a decrease in the risk of metastasis at the time of diagnosis and to a decrease in specific mortality from prostate cancer, according to researchers Edmund M. Qiao, a fourth-year medical student. year at the University of California at San Diego. La Jolla.
The new study, from a large national cohort of black men aged 40 to 55, was presented at a press conference last week ahead of the annual meeting of the American Society of Clinical Oncology (ASCO). The meeting will be held from June 4 to 8 for the second year in a row.
The new findings, which will be presented at the June 6 plenary session, are particularly important because black men are underrepresented in PSA screening studies on which evidence-based prostate cancer screening guidelines are based, he said. comment Qiao.
This limits “appropriate” PSA screening guidelines for black men, especially those under the age of 55 who have not been included in any of the studies on 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, summed up ASCO session moderator and president Lori Pierce, MD, of the Rogel Cancer Center at the University of Michigan and Ann Arbor.
“A step to solve disparities”
According to the study’s authors, the most recommended age to start the PSA screening debate is 40 years old. Therefore, the team identified 4726 black men aged 40 to 55 diagnosed with prostate cancer from 2004 to 2017 in the Veterans Health Administration database. The mean age was 51.8 years with a mean PSA detection rate of 53.2%.
Screening intensity was defined as the percentage of years selected within the pre-diagnosis observation period (restricted to 5 years before diagnosis) and the study group was stratified into high or low (medium-centered) screening.
Overall PSA screening in the cohort averaged 1.9 tests. In terms of stratification, high PSA screening consisted of an average of 3 trials (61% of the cohort). Low PSA screening consisted of an average of 0.5 trials (10.6% of the cohort).
The low screening frequency group (compared to the high group) was more likely to have, at diagnosis, a Gleason score ≥8 (18.6% vs 14.4%) as well as metastatic disease (3.7 % vs 1.4%)
Overall, the increase in PSA screening intensity was associated with a 40% reduction in the relative risk of metastatic disease at the time of diagnosis and a 25% reduction in the relative risk of cancer-specific death. of prostate, Qiao stressed.
It should be noted that in his conclusion, Qiao said that the detection of PSA in young black men was “a step in addressing racial disparities in prostate cancer.” This was a recognition that other variables play a role in cancer outcomes for black men.
These 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 March. editorial this is relevant for the new study.
Brawley noted 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 features are used to determine the concept called race, which was developed 300 years ago to justify the enslavement of Africans and which anthropologists consider unscientific, Brawley noted.
“The use of race can often cloud real problems that influence health status and outcomes,” he says, listing several examples of such problems as the diagnosis and differences in treatment that result from overcrowded hospital staff. poor neighborhoods.
In prostate cancer, specific areas of geographical origin – which reflect ancestry and not race – are “important,” Brawley also says. “Men of West African descent have a higher incidence of prostate cancer,” she says.
But powerful forces also play a role, 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 Annual Meeting of the American Society of Clinical Oncology: Summary 5004. To be presented June 6, 2021.
Nick Mulcahy is an award-winning senior Medscape oncology journalist who can be contacted [email protected] i on Twitter: @MulcahyNick . For more information on Medscape Oncology, join us Twitter i Facebook