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From the Winter 2018 Quest
Like a flower, each person is unique. Personalizing screening and treatment for an individual requires a multi-layered approach. photos by Jan Catalona
Previous scientific studies have found that African American men are more likely to be diagnosed with prostate cancer and more likely to die from the disease when compared to men of other racial backgrounds. Current research continues to look for the cause of this disparity.

Dr. Catalona was a co-author on a study that found a link between men who self-reported their race as Black and prostate cancer.1 The association was present even after taking socioeconomic and other clinical factors into account. This link could stem in part from genetic or biological factors.

The investigators recruited 564 men for the study. At the time of their first biopsies, the men who identified themselves as Black had higher PSAs scores than men of other races. Black men were more likely to have cancer, and that cancer was more likely to be clinically significant.

The disparity was even greater for younger Black men ages 40-55 years old. These men had a 5.7-fold increased risk of developing prostate cancer. Yet, the current United States Preventive Services Task Force (USPSTF) does not give specific guidelines for screening Black men for prostate cancer at a younger age.

The authors of this study concluded that because Black race is associated with an increased likelihood of developing prostate cancer at a younger age, further investigation is needed to identify the best screening approach for Black men.

Using a baseline midlife PSA to personalize screening

One potential approach to screening Black men could be the use of a midlife PSA to establish a baseline risk level. A higher PSA at a younger age is a strong predictor of the future development of significant prostate cancer.

A new study led by a team at Brigham and Women's Hospital in Boston looked at midlife PSA scores in Black men and the future risks of developing aggressive prostate cancer with a Gleason score of 7 or higher.2

The researchers found that when compared with PSA values at or below the median, men with PSA values above the 90th percentile were more likely to develop aggressive prostate cancer. For Black men ages 40-54, a PSA above the 90th percentile was associated with an 84-fold higher risk of developing prostate cancer - and a 174-fold increased risk of developing aggressive prostate cancer. They concluded that Black men with higher PSA scores in midlife should undergo more intensive PSA screening to detect - and treat - cancer while it is still curable.

The investigators said these results are similar to previous studies that included both Black men and Caucasian men. For example, a large 2016 study assessed midlife PSA as a predictor of future aggressive prostate cancer in 22,071 U.S. male physicians.3 The study's findings also supported the use of a midlife PSA as an aid to stratify prostate cancer screening based on an individual's risk level. The risk of lethal prostate cancer was strongly associated with a midlife PSA above the 90th percentile. Men ages 40-49 years old in this category had an 8.7-fold increased risk of later developing lethal prostate cancer. For men 50-54 years old, there was a 12.6-fold increased risk.

1 Nettey OS et al, doi:10.1016/j.urolonc.2018.06.011
2 Eur Urol. 2018 Sep 17. pii: S0302-2838(18)30627-4. doi: 10.1016/j.eururo.2018.08.032.
3 DOI: 10.1200/JCO.2016.66.7527 Journal of Clinical Oncology - published online before print September 27, 2016

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