Evaluating Prostate-Specific Antigen Screening for Young African American Men With Cancer.

Journal Article (Journal Article)

Background

Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients.

Methods

We identified African American men aged 40-55 years, diagnosed with prostate cancer between 2004 and 2017 within the Veterans Health Administration. Inverse probability of treatment-weighted propensity scores were used in multivariable models to assess PSA screening on PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on prostate cancer-specific mortality (PCSM), with noncancer death as competing events. All statistical tests were 2-sided.

Results

The cohort included 4726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1057 (22.4%) with no PSA screening prior to diagnosis. Compared with no screening, PSA screening was associated with statistically significantly reduced odds of PSA levels higher than 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49 to 0.63; P < .001), Gleason score of 8 or higher (OR = 0.78, 95% CI = 0.69 to 0.88; P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39 to 0.64; P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36 to 0.76; P  < .001). Primary care provider visits displayed similar effects.

Conclusions

Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.

Full Text

Duke Authors

Cited Authors

  • Qiao, EM; Lynch, JA; Lee, KM; Kotha, NV; Nalawade, V; Voora, RS; Qian, AS; Nelson, TJ; Yamoah, K; Garraway, IP; Stewart, TF; Parsons, JK; Rose, BS

Published Date

  • April 2022

Published In

Volume / Issue

  • 114 / 4

Start / End Page

  • 592 - 599

PubMed ID

  • 34893859

Pubmed Central ID

  • PMC9002290

Electronic International Standard Serial Number (EISSN)

  • 1460-2105

International Standard Serial Number (ISSN)

  • 0027-8874

Digital Object Identifier (DOI)

  • 10.1093/jnci/djab221

Language

  • eng