ASCO 2021: Does PSA Screening Intensity Impact Outcomes in Younger Black Men With Prostate Cancer?
Posted: Thursday, May 20, 2021
Black men have been poorly represented in prostate-specific antigen (PSA) screening studies; thus, evidence-based screening guidance is limited in this population, especially those younger than age 55. Brent S. Rose, MD, of the University of California San Diego, and colleagues conducted a study to determine whether PSA screening intensity may be associated with disease severity at diagnosis and prostate cancer–specific mortality in this patient population. Their findings were presented in a presscast in advance of the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 5004).
“This study lends weight to the importance of discussions between doctors and individual patients about the risks and benefits of PSA screening,” commented Lori J. Pierce, MD, FASTRO, FASCO, 2020–2021 ASCO President, in an ASCO press release.
“In this large national cohort of [Black] men aged 40 to 55 years, [increased intensity of PSA screening] was associated with a decreased risk of lethal disease and metastases at [the] time of diagnosis and decreased prostate cancer–specific mortality,” the investigators commented. “These data support the hypothesis that PSA screening and early prostate cancer detection may improve outcomes in younger [Black] men.”
The investigators focused on 4,654 Black men, at a mean age of 51.8 years, who were diagnosed with prostate cancer within the Veterans Health Administration. Screening intensity was defined as the percentage of years in which patients underwent PSA screening during the prediagnostic observation period. Patients were stratified into high- (an average of 3 previous PSA tests) and low-intensity (an average of 0.5 previous PSA tests) PSA screening groups.
Compared with patients who underwent high-intensity PSA screening, there seemed to be an increased prevalence of metastatic disease (3.7% vs. 1.4%; P < .01) and tumors with a Gleason grade group of at least 4 (18.6% vs. 14.4%; P < .01) at diagnosis in those who underwent low-intensity PSA screening. Increased PSA screening intensity seemed to be associated with significantly reduced odds of metastatic disease at diagnosis (odds ratio = 0.61; P < .01) and a decreased risk of prostate cancer–specific mortality (subdistribution hazard ratio = 0.75; P = .02).
Disclosure: Dr. Rose reported no conflicts of interest. For full disclosures for the other study authors, visit coi.asco.org.