Predicting Aggressive Prostate Cancer in Black Men
Posted: Thursday, January 3, 2019
Because above-median prostate-specific antigen (PSA) levels in black men at midlife “strongly predict” the later development of prostate cancer—most notably, aggressive prostate cancer—men with these levels would benefit from vigorous follow-up and “personalized screening strategies” to identify cancer at an earlier, potentially curable stage. This study finding was published in European Urology.
Mark A. Preston, MD, MPH, of Brigham and Women’s Hospital in Boston, and colleagues conducted “the largest [ever] prospective study exploring prediction of prostate cancer by baseline PSA in a population of black men.” They used data and blood samples, including PSA measurements, of black men who participated in the Southern Community Cohort Study. A total of 86,000 men and women in 12 Southeastern states enrolled between 2002 and 2009.
Using state cancer registry linkages, the researchers identified 197 black men who had developed prostate cancer (including 91 aggressive cases) by 2015 but who had been cancer-free upon study enrollment. Each patient was matched with three cancer-free controls.
“Midlife PSA predicts subsequent aggressive prostate cancer better than either family history or race,” concluded Dr. Preston and his team. In fact, “95% of total and 97% of aggressive cases had baseline PSA [levels] above the age-specific median.”
The odds ratio for developing any prostate cancer, comparing baseline PSA more than 90th percentile versus less than or equal to the median, was 83.6 for black men between the ages of 40 and 54 and 71.7 for those between the ages of 55 and 64. For aggressive prostate cancer, the odds ratios were 174 and 51.8 for both age groups, respectively.
Disclosure: Study authors’ disclosure information may be found at European Urology.