New prostate screening guidelines organized by the Prostate Cancer Foundation aim to address the longstanding health disparity in prostate cancer: Black men are diagnosed with and die from prostate cancer at a much higher rate than white men.
And the stats are alarming. According to the American Cancer Society, Black men are 70% to 110% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease.
In an effort to help reduce these disparities, a panel of diverse, interdisciplinary experts was formed to establish practical guidelines addressing prostate-specific antigen (PSA)-based screening in Black men.
These new guidelines, which most notably include having baseline PSA testing starting between the ages of 40-45, were presented by Isla Garraway, MD, PhD, professor and director of research in urology at the David Geffen School of Medicine at UCLA and scientist in the UCLA Health Jonsson Comprehensive Cancer Center, during the 2024 ASCO Genitourinary Cancers Symposium in San Francisco and published in NEJM Evidence.
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“These guidelines were specifically formulated to provide practical recommendations for Black men as they consider their individual risk of prostate cancer and engage in shared decision-making with their health care providers,” said Dr. Garraway. “Early detection of prostate cancer is one of several factors that the panel believes could reduce prostate cancer morbidity and mortality in this high-risk population.”
To develop the guidelines, the panel performed a comprehensive literature search that was conducted in April 2023 using PubMed and Embase databases. A total of 287 studies were reviewed.
Through the review, the panel developed six guideline statements:
1. Since Black men are at high risk for prostate cancer, the benefits of screening generally outweigh the risks.
Although PSA screening may yield false-positive test results for some men that can prompt additional testing and lead the diagnosis of non-symptomatic or non-lethal issues, prostate cancer in Black men occurs at a younger age and is associated with higher rates of progression and prostate cancer death. Early detection through screening may provide an opportunity for timely intervention and better outcomes.
Black men are 1.8 times more likely to be diagnosed with—and 2.4 times more likely to die from—prostate cancer than white men in the United States.
"There are likely various factors converging to contribute to a higher incidence of prostate cancer in Black men, along with a tendency for more aggressive forms of the disease," explained Dr. Garraway. "These factors may include genetic ancestry, exposure to environmental carcinogens, and the impact of stress, which can affect overall health."
2. PSA is a blood test that should be considered first-line for prostate cancer screening.
A PSA test is a common tool used by doctors to screen for and monitor prostate health by measuring levels of PSA in the blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate. Elevated PSA levels detect not only aggressive prostate tumors, but also very slow-growing cancers that are unlikely to become life-threatening. If PSA levels are higher than normal, further diagnostic tests, such as a biopsy, may be recommended to assess the possibility of prostate cancer or other issues affecting the prostate.
3. Decisions about PSA testing depend on individual preferences.
Black men should engage in shared decision-making with their health care providers and other trusted sources of information to learn about the pros and cons of screening.
4. For Black men who elect screening, a baseline PSA test should be done between ages 40-45.
Currently, the U.S. Preventive Services Task Force recommends PSA screening be a topic of conversation for men ages 55-69 and their doctors, with discussion of whether to get the test based on their risk factors. However, there are no specific recommendations for PSA-based prostate cancer screening among Black men.
In the analysis, the panel found studies suggest that discussions with health care providers about baseline PSA testing should begin by the time Black men are in their early 40s and data suggests prostate cancer develops three to nine years earlier in Black men compared to their peers. Lowering the age for baseline PSA testing to 40-45, followed by regular screening intervals until the age of 70, would reduce prostate cancer mortality in Black men without significantly increasing the rate of overdiagnosis.
5. Black men over the age of 70 who have been undergoing prostate cancer screenings should talk with their health care provider about whether to continue PSA testing.
Men older than 70 should be talking with their physician about whether to continue PSA testing and make an informed decision based on their age, life expectancy, health status, family history and prior PSA levels.
6. Black men with an even higher risk of prostate cancer due to strong family history should consider annual PSA screening as early as age 40.
Personalized prostate cancer surveillance and/or treatment can prevent potential harms from overdiagnosis. Depending on the PSA value and health status, annual screening should be strongly considered.
*This article was originally published on February 5, 2024 and updated to included the NEJM Evidence publication.
