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Black men may face an increased risk of prostate cancer than white men at lower PSA levels

Black men in the US usually tend to develop prostate cancer than white men, and after diagnosis, they’re more more likely to have advanced disease and to die than white men with the disease. Although it might seem that earlier prostate‐specific antigen (PSA) screening could reduce the chance of fatal prostate cancer in Black men, latest research indicates that at any given PSA level, Black men usually tend to harbor prostate cancer than white men, indicating that they might face an increased risk of prostate cancer than white men at lower PSA levels. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

For the study, researchers used models to predict the likelihood of prostate cancer diagnosis from a primary biopsy for 75,295 Black and 207,658 white male Veterans receiving care from the U.S. Department of Veterans Affairs (VA). Prostate cancer was detected in the primary prostate biopsy in 55% of Black men and in 43% of white men. After taking various competing aspects into consideration, Black Veterans were 50% more more likely to receive a prostate cancer diagnosis based on their first prostate biopsy than white Veterans.

Also, Black men with a pre-biopsy PSA of 4.0 ng/mL had a 49% risk of prostate cancer detected during their biopsy, compared with a 39% risk for white men with the identical PSA level. The investigators’ model indicated that Black Veterans with a PSA of 4.0 ng/mL had an equivalent risk of prostate cancer as white Veterans with a PSA of 13.4 ng/mL.

These findings suggest that to cut back health disparities for Veterans within the prevention of prostate cancer, clinicians should consider a person Veteran’s risk for prostate cancer including aspects similar to race and age. Clinicians may consider earlier screening for populations at greater than average risk, which incorporates Black men.”

Kyung Min Lee, PhD, First Creator, VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System

The VA recommends that for average risk men ages 55–69 years, any decision to initiate or proceed prostate cancer screening with PSA ought to be individualized, noted Jane Kim, MD, MPH, Executive Director for Preventive Medicine within the VA. “This includes consideration of age, family history, race/ethnicity, medical conditions, and patient values, in addition to potential advantages versus harms. Per the U.S. Preventive Services Task Force, before deciding whether to be screened, men must have a chance to debate the advantages and harms of screening through shared decision making with their clinicians,” she said.

Dr. Lee added that prospective studies are needed to guage the risks and advantages of lower PSA biopsy thresholds informed by patient race and genetic risk scores. ”The VA Office of Research & Development has recently initiated the ProGRESS clinical trial-;The Prostate Cancer, Genetic Risk, and Equitable Screening Study-;to guage these questions,” he said.


Journal reference:

Lee, K. M., et al. (2023) Association between prediagnostic PSA and prostate cancer probability in Black and non-Hispanic White men. Cancer.

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