Improved Outcomes for Younger African Americans Linked to Increased PSA Screening

Improved outcomes for younger African American patients is associated with increased prostate-specific antigen (PSA) screening, according to findings presented on a presscast held ahead of the 2021 ASCO Annual Meeting.

In this population, an increase in the frequency of PSA screening was linked to a nearly 25% reduction in prostate cancer–specific mortality and an approximately 40% lower risk of having metastatic disease at the time of a prostate cancer diagnosis.

“We found that PSA screening was associated with a decreased risk of Gleason score ≥8, PSA >20, and metastatic disease at diagnosis, as well as prostate cancer–specific mortality. Taken together, these results would suggest that [increased] PSA screening may improve cancer outcomes for young African American men. Although the results of this study are just one step in addressing all of the other racial disparities that still exist in prostate cancer,” said lead author Edmund M. Qiao, BS, of the University of California San Diego.

Overall, the study included 4726 African American men diagnosed with prostate cancer. The mean patient age was 51.8 years. The mean number of previous PSA screening tests was 1.9. The “high PSA screening” group had received an average of 3 prior screening tests and the “low PSA screening” group had received an average of 0.5 prior screening tests.

Regarding disease severity at diagnosis, all key metrics showed that the high PSA screening group had lower severity. Specifically, the rate of patients with Gleason score ≥8 and PSA >20 at diagnosis was 15.3% versus 10.7% and 16.3% versus 7.2% in the lower versus higher screening groups, respectively. Further, the rate of metastatic disease at diagnosis was 4.2% versus 1.4%, respectively, translating to a 39% risk reduction (odd ratio, 0.61; 95% CI, 0.47-0.81; P <.01).

Qiao added, “In our statistical model, controlling for the confounders, we found that PSA screening was associated with about a 25% reduction in prostate cancer–specific mortality [hazard ratio, 0.75; 95% CI, 0.59-0.95; P = .02].” The confounding factors controlled for in the statistical model included primary care visit rate, age at diagnosis, year of diagnosis, Charlson comorbidity score, employment, marital status, college education, and income.

Regarding the importance of the research, Qiao said, “African American men have the highest mortality rate for prostate cancer; however, the data for PSA screening includes very few African American men and no young African American men between the ages of 40 and 55. This has led to discordant PSA screening recommendations for these patients and as a result, young African American men are an at-risk group that needs additional research to help guide their clinicians and themselves when deciding when to start PSA screening.”

In 2012, the US Preventive Services Task Force (USPSTF) issued a grade D recommendation against the use of PSA screening in the general US population, regardless of age. The current USPSTF PSA screening policy is slightly changed, with a grade C recommendation for men aged 55 to 69 years, meaning in this population, an individual decision on screening should be made based on a physician-clinician discussion of the potential benefits and risks.

While the USPSTF acknowledges that family history and African American race are two of the most significant risk factors for developing prostate cancer, the panel maintains that there is insufficient evidence to issue individualized screening recommendations in any age group based on those factors.

Commenting on the study during the presscast, ASCO President Lori J. Pierce, MD, FASTRO, FASCO, said, “We know African American men are nearly one-and-a-half times more likely to develop prostate cancer and more than twice as likely to die from prostate cancer as White patients. And despite this, young African American men are poorly represented in PSA studies from which evidence-based guidelines are developed. So, this really limits proper PSA guidance screening guidance for African American patients, especially for those who are younger than 55. And so, because we don't have adequate screening data, there are differences in opinion as to what the guidelines should be. And so, this abstract makes a very strong statement to discuss screening at a younger age in African American men.”

_Reference

_{1. Qiao E, Kotha N, Nalawade V, et al. Association of increased intensity of prostate-specific antigen screening in younger African American men with improved prostate cancer outcomes. Presented at: 2021 ASCO Annual Meeting Virtual Embargoed Presscast; May 14, 2021. Abstract 5004.}