Prostate-Specific Antigen Screening Intensities and Racial Disparity in Prostate Cancer Diagnoses

Citing a lack of data on prostate-specific antigen (PSA) screening in African American (AA) men in the United States, researchers analyzed data from a large health system and evaluated frequencies of screening in AA men compared to White men, as well as the effect of different screening intensities on diagnoses of prostate cancer (PCa). The report was presented at the 22nd Annual Meeting of the Society of Urologic Oncology.

The study’s lead author, Deepansh Dalela, and his colleagues observed that, over nearly 20 years, fewer AA men underwent routine screening, as defined by the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial guidelines.

Further, the study highlighted that AA men who underwent occasional or sporadic PSA testing presented with worse tumor characteristics at PCa diagnosis than White men with similar screening intensity, “suggesting intrinsic differences in tumor biology between AA versus White men,” Dalela speculated.

Participants were men who identified as AA or White, did not have a PCa diagnosis, and had at least one prior PSA screen. Screening frequency was assessed over a five-year window and defined as routine (at least one screen every one to two years), occasional (at least one screen every three years), or sporadic (no screen in three consecutive years). Outcome variables were time to diagnosis of PCa, PSA, Gleason score, and stage at diagnosis.

A total of 46,693 (34.5%), 44,790 (33.1%), and 44,015 (32.5%) men were assigned to the sporadic, occasional, and routine PSA screening groups, respectively. AA men represented 25.6% of all patients. While AA men were generally younger at their first PSA screen (median age = 54.9 vs. 57.8 years), they were less likely to receive routine screening (29.4% vs. 33.6%) (both p < 0.001) compared to White men.

Over the median follow-up period, the cumulative incidence of PCa between AA and White men in the sporadic, occasional, and routine group was 3% versus 1%, 5% versus 2%, and 9% versus 4%, respectively (all p < 0.001).

Dalela concluded that, while prior studies have compared the overall rates of PSA screening between AA and White men in the United States, this study is among the first to examine the effects of varying screening frequency on PCa diagnoses.