Experts develop guidelines for prostate cancer screening in Black men

A panel of interdisciplinary experts have developed a set of practical guidelines regarding prostate-specific antigen (PSA) screening for prostate cancer in Black men, notably placing an emphasis on shared decision-making and recommending that baseline PSA testing be done in men as early as 40 to 45 years of age.¹

The guideline panel was made up of experts in the fields of primary care, urology, medical and radiation oncology, and translational science, as well as patient advocates.

The guidelines were organized by the Prostate Cancer Foundation and presented by Isla P. Garraway, MD, PhD, at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California. Garraway is a professor and director of research in urology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) and a scientist in the UCLA Health Jonsson Comprehensive Cancer Center.

“These guidelines were specifically formulated to provide practical recommendations for Black men as they consider their individual risk of prostate cancer and engage in shared decision-making with their health care providers,” said Garraway in a news release.² “Early detection of prostate cancer is one of several factors that the panel believes could reduce prostate cancer morbidity and mortality in this high-risk population.”

The guideline panel was made up of experts in the fields of primary care, urology, medical and radiation oncology, and translational science, as well as patient advocates. The group assessed 265 relevant pieces of literature obtained from PubMed and Embase in April 2023.

After analyzing the relevant literature, the panel developed 6 guideline statements.

• Since Black men are at high risk for prostate cancer, the benefits of screening generally outweigh the risks.
• PSA is a blood test that should be considered first-line for prostate cancer screening. Some providers may recommend an optional digital rectal exam in addition to the PSA test.
• Decisions about PSA testing depend on individual preferences. Black men should engage in shared decision-making with their health care providers and other trusted sources of information to learn about the pros and cons of screening.
• For Black men who elect screening, a baseline PSA test should be done between ages 40 to 45. Depending on the PSA value and the individual’s health status, annual PSA screening should be strongly considered.
• Black men over the age of 70 who have been undergoing prostate cancer screening should talk with their health care provider about whether to continue PSA testing and make an informed decision based on their age, life expectancy, health status, family history, and prior PSA levels.
• Black men with an even higher risk of prostate cancer due to strong family history and/or known carriers of high-risk genetic variants should consider initiating annual PSA screening as early as age 40.

The decision to lower the age for baseline PSA testing to 40 to 45 years was in part based on modeling data suggesting that prostate cancer develops 3 to 9 years earlier in Black men compared with their peers.

The authors wrote, “Lowering the age for baseline PSA testing from 50-55 years to 40-45, followed by regular screening intervals until the age of 70 (when to stop is determined by age, PSA values, and health factors) would reduce prostate cancer mortality in Black men (~30% relative reduction) without significantly increasing the rate of overdiagnosis.”

The authors also recommended revisiting the current recommendations for early prostate cancer detection in Black men from other national guidelines.

References

1. Garraway I. Prostate Cancer Foundation (PCF) screening guidelines for prostate cancer in Black men in the United States. Presented at 2024 ASCO Genitoruinary Cancers Symposium. San Francisco, California. January 25-27, 2024. Abstract 264

2. Prostate cancer screenings encouraged for Black men as early as 40. News release. University of California, Los Angeles (UCLA), Health Sciences. February 6, 2024. Accessed February 8, 2024. https://www.newswise.com/articles/prostate-cancer-screenings-encouraged-for-black-men-as-early-as-40