Prostate specific antigen (PSA) levels in midlife are a strong prostate cancer predictor in black men.
In the USA, black men are more likely to be diagnosed with and die from prostate cancer. Despite this, screening recommendations are primarily based on studies of white men. Optimizing the screening process for African American men, then, could go some way toward tackling the prostate cancer health disparity.
Lorelei Mucci, MPH, ScD, Associate Professor of Epidemiology at the Harvard T.H. Chan School of Public Health, and co-lead author of the paper, said: “Black men in the US are 2.5 times more likely to die of prostate cancer compared to white men, yet screening studies to date have largely been focused on white men.”1
A research team from Brigham and Women’s Hospital (BWH) and Harvard T.H. Chan School of Public Health looked at data from the Southern Community Cohort Study (SCCS). This collection contains information on 86,000 men and women from south east US.
The records of 197 African American men aged between 40 and 64 who developed prostate cancer, including 91 cases of aggressive disease, were compared to those of 596 matched controls.
Overall, 95% of those who went on to develop the cancer had above average baseline PSA levels for their age. Among those with aggressive disease, the figure was 97%.
“We found that a single, baseline PSA level measured during midlife strongly predicted subsequent diagnosis of total and aggressive prostate cancer up to 12 years after a blood draw,” said co-lead author Mark Preston, MD, MPH, urologic surgeon in the Division of Urology at BWH.1
“Our findings suggest that targeted screening based on a midlife PSA might identify black men at high risk of aggressive prostate cancer while minimizing screening in those at low risk.”
It is hoped that these findings, which were published in European Urology, will go some way toward helping tackle the prostate cancer health disparities affecting African American men.
Dr. Mucci said: “The data from our study address a critical gap in understanding the substantial racial disparities and suggests a potential strategy to reduce prostate cancer death in black men.”1
The authors noted that increased risk was seen with PSA levels that were higher than average but still well within the “normal” range that would not usually trigger follow-up in clinical practice.2
“These findings do not imply that prostate biopsy or definitive treatment is immediately required in younger men with higher PSA levels at baseline, as this could lead to over-diagnosis, but that they undergo more intensive PSA screening to enable earlier identification of cancer and potential cure while still possible,” they concluded.
- Brigham and Women’s Hospital (2018). In black men, baseline screening in midlife strongly predicts aggressive prostate cancer. [online] Available at: https://www.eurekalert.org/pub_releases/2018-10/bawh-ibm101018.php (accessed March 2019).
- Preston MA, et al. Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men. Eur Urol 2018; pii: S0302-2838(18)30627-4.