Black men potentially impacted negatively by fewer PSA screenings
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Dr. David Samadi gives his expert opinion on recent findings that recommendations against routine PSA screening can adversely affect black men who are already at a higher risk for metastatic prostate cancer.
The recent 2017 Genitourinary Cancers Symposium in Orlando questioned whether the recommendations from the 2012 US Preventative Services Task Force (USPSTF) in regards to PSA screenings could have a negative impact for black men who already have higher rates of prostate cancer-related mortality and a later stage of prostate cancer diagnosis.
“This has always been a grave concern of mine and that is one of the reasons why I was not in favor of the Task Force recommendation back in 2012,” stated Dr. David Samadi. “We have known for years that African American men represent a high-risk group for prostate cancer and yet are significantly less likely than other men to use early detection screening tools like prostate-specific antigen testing for prostate cancer.”
The 2012 replaced the 2008 recommendation which had recommended against PSA-based screening for prostate cancer in men aged 75 or older and concluded that the evidence was insufficient to make a recommendation for younger men. Now the USPSTF recommends against PSA-based screening for prostate cancer in all age groups.
Researchers from the Harvard Radiation Oncology Program in Boston compared the risks of prostate cancer metastasis and mortality by black and non-black race. The goal was to find out the outcomes for men before the USPSTF recommendations were made. In order to do this they used the Surveillance, Epidemiology, and End Results (SEER) database and looked at outcomes for 390,259 men diagnosed with prostate cancer between 2004 to 2011.
Results showed black men were 65% more likely to be diagnosed with metastatic prostate cancer than non-black men with their risk of dying from the disease to be 36% higher.
“I recommend for every man to get what we call a baseline PSA screening starting at age 40,” advised Dr. Samadi. “This has always been our first line of defense against prostate cancer and prostate diseases. It is not clear exactly why African American men have higher rates but what we do know is that this silent killer occurs less often in Asian-American and Hispanic men when compared to black men.”
Another finding from this research was that there were significant interactions between race and PSA screening eligibility. Black men ages 55 to 69, who met the age criteria for PSA screening, had higher risk (76% vs 55%) and prostate cancer mortality (53% vs 25%) than ineligible patients. This finding led researchers to speculate that black men of screening age could be disproportionately and negatively impacted by the 2012 recommendations to end PSA screening.
“This is not the findings we want to see and it is disappointing news,” exclaimed Dr. Samadi. “African American men have a 60-70% increased risk of prostate cancer over white men. Not only do they have the highest rate of new prostate cancer cases in the United States but they also have the highest proportion of aggressive prostate cancers. We need to work very hard on preventing black men from falling through the cracks.”
Dr. Samadi went on to add, “Our best line of defense is the PSA screening test. Yes, it is true that with PSA screening you may overdiagnose but overdiagnosis should not lead to overtreatment. Every man I see is treated as an individual. All men should talk to their doctor to find out what’s best for them. Having a frank discussion with your doctor can help avoid unnecessary surgery which is why men should find a doctor who is an expert in prostate cancer. All urologists should encourage and make it easier for black men to be screened for this potentially deadly disease.”
Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi. For a free phone consultation and to learn more about prostate cancer risk, call 212-365-5000.