Black men have higher risk of prostate cancer at any PSA level

New data published in the journal Cancer suggest that Black men are more likely to harbor prostate cancer than White men at the same prostate-specific antigen (PSA) levels.¹

Black men with a pre-biopsy PSA of 4.0 ng/mL had a 49% risk of prostate cancer, compared with a 39% risk among White men with the same PSA level.

The study included 75,295 Black and 207,658 White male veterans who were receiving care at the US Department of Veteran Affairs (VA). Predictive models were used to determine the likelihood of a prostate cancer diagnosis at first biopsy. Predictors included self-identified race, age at first PSA test, prebiopsy PSA, age at first biopsy, smoking status, statin use, and socioeconomic factors.

Overall, 55% of Black men were found to have prostate cancer upon initial biopsy, compared with 43% of White men. Black veterans were 50% more likely than White veterans to receive a diagnosis of prostate cancer on first biopsy after accounting for PSA and other factors.

When assessing the risks by PSA level, Black men with a pre-biopsy PSA of 4.0 ng/mL had a 49% risk of prostate cancer, compared with a 39% risk among White men with the same PSA level. The model also indicated that Black men with a PSA of 4.0 ng/mL had a risk of prostate cancer that equaled that of White men with a PSA of 13.4 ng/mL.

“These findings suggest that to reduce health disparities for Veterans in the prevention of prostate cancer, clinicians should consider an individual Veteran’s risk for prostate cancer including factors such as race and age. Clinicians may consider earlier screening for populations at greater than average risk, which includes Black men,” said first author Kyung Min Lee, PhD, in a news release on the findings.² Lee is a research health scientist at the VA Informatics and Computing Infrastructure, located within the VA Salt Lake City Health Care System.

The VA recommends that prostate cancer screening with PSA should be individualized for men of average risk aged 55 to 69 years, noted Jane Kim, MD, MPH, Executive Director for Preventive Medicine in the VA. “This includes consideration of age, family history, race/ethnicity, medical conditions, and patient values, as well as potential benefits versus harms. Per the U.S. Preventive Services Task Force, before deciding whether to be screened, men should have an opportunity to discuss the benefits and harms of screening through shared decision making with their clinicians,” she said in the news release.²

However, the authors indicated that further prospective studies are needed to assess PSA screening in Black men and other high-risk patient populations. To that end, the VA has initiated the ProGRESS clinical trial (NCT05926102) to determine the risks and benefits of lower PSA biopsy thresholds based on race and genetic risk scores, among other measures.

The ProGRESS study is expected to enroll 5000 adult participants who will be randomly assigned to receive a precision screening intervention with a prostate cancer genetic risk assessment or standard care. The primary outcome measures are the diagnosis of clinically significant prostate cancer and prostate biopsies. Patients will be assessed for 7 years.³

References

1. Lee KM, Bryant AK, Lynch JA, et al. Association between prediagnostic PSA and prostate cancer probability in Black and non-Hispanic White men. Cancer. 2023. doi:10.1002/cncr.34979

2. At the same PSA level, Black men are more likely to have prostate cancer than white men. News release. Wiley. November 6, 2023. Accessed November 14, 2023. https://www.newswise.com/articles/at-the-same-psa-level-black-men-are-more-likely-to-have-prostate-cancer-than-white-men

3. The prostate cancer, genetic risk, and equitable screening study (ProGRESS) (ProGRESS). ClinicalTrials.gov. Last updated July 17, 2023. Accessed November 14, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT05926102