Black men more likely to receive prostate cancer diagnosis after raised PSA

A recent study published in BCM Medicine found that Black men were significantly more likely to be diagnosed with prostate cancer following a raised prostate specific antigen (PSA) test result compared with White or Asian men, but rates of advanced prostate cancer were not higher among Black men.¹

The authors note that further research is needed on the effects of applying different PSA thresholds on different ethnic groups.

“Our study sought to investigate the performance of the PSA test in identifying prostate cancer among men in different ethnic groups in the UK. We found that PSA levels vary by ethnicity, Black men had higher PSA levels than White men, and Asian men had the lowest PSA levels,” said lead author Elizabeth Down in correspondence with Urology Times®. Down is a graduate research assistant at the University of Exeter in the UK.

In total, the study included 730,515 men with prostate cancer who had an evaluable PSA test result. Among those, 88.9% of patients were White. PSA tests were carried out between 2010 and 2017.

Patient data were obtained from English primary care-linked patient records. Covariates included in the analysis were year of blood test, age in 5-year age-bands, deprivation, alcohol intake, smoking status, and body mass index.

Data showed that Black men and men with mixed ethnicity tended to have higher PSA test values, especially among those aged 60 or older. Conversely, Asian men were found to have the lowest PSA values.

In the year following a raised PSA result, prostate cancer incidence using age-adjusted thresholds was 24.7% (95% CI, 23.3%-26.2%) among Black men, 19.8% (95% CI, 19.4%-20.2%) among White men, and 13.4% (95% CI, 12.2%-14.7%) among Asian men. Men with mixed ethnicity demonstrated an estimated incidence of 19.4% (95% CI, 16.6%-22.6%), and men of other ethnic groups demonstrated an estimated incidence of 15.9% (95% CI, 13.2%-19.0%).

All groups observed the peak incidence of prostate cancer in men aged 70 to 79.

Further, the investigators found that the incidence of advanced stage prostate cancer following a raised PSA result was similar among Black men and White men. Specifically, the rate was 7.5% (95% CI, 7.3%-7.8%) among White men, 7.0% (95% CI, 6.1%-7.8%) among Black men, and 4.5% (95% CI, 3.8%-5.3%) among Asian men.

When stratifying rates of advanced prostate cancer by age group, White men had the highest incidence of disease in the oldest age groups (ages 70 to 79 and 80 and older). Black men were shown to have the highest rate of advanced prostate cancer among the youngest age group (40 to 49 years) at 3.2%, although the confidence interval overlaps with that of White men (White men: 1.4%; 95% CI, 1.0%-1.8%; Black men: 3.2%; 95% CI, 1.7%-4.8%).

Additionally, Asian men were shown to have the lowest rates of advanced prostate cancer, especially among men aged 40 to 69 years.

Down added, “Diagnosis of prostate cancer after a raised PSA result was highest in Black men, and lowest in Asian men. However, advanced prostate cancer levels between Black men and White men were very similar, suggesting that the relatively higher PSA levels may be influencing prostate cancer diagnosis in Black men, potentially leading to overdiagnosis of low-grade disease.”

The authors note that further research is needed on the effects of applying different PSA thresholds on different ethnic groups to determine if adjustments to the current thresholds are warranted.

They concluded, “When designing screening programs or advice for clinicians on opportunistic screening, it may be necessary to consider the possibility that the identified differences in PSA distribution and prostate cancer incidence in the different ethnic groups may lead to differential under- or over-diagnosis in certain groups. Although early diagnosis of prostate cancer is important to improve outcomes, any testing program would need to carefully consider this evidence to ensure that new guidelines did not lead to inferior outcomes for people from any ethnic group.”

Reference

1. Down L, Barlow M, Bailey SER, et al. Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK. BMC Med. 2024;22(1):82. doi:10.1186/s12916-024-03283-5