Prostate Cancer: African American Men and Screening

David M. Albala, MD Associated Medical Professionals of NY, PLLC Syracuse, NY 13210MedicalResearch.com Interview with:
David M. Albala, MD
Associated Medical Professionals of NY, PLLC
Syracuse, NY 13210


MedicalResearch.com: What are the main findings of the study?

Dr. Albala: Prostate cancer is the second leading cause of cancer death and American man. Prostate cancer diagnosis and mortality differences between African American and Caucasian populations have been highlighted in the literature. Research has shown that African American males are at a biological predisposition for prostate cancer and that additional socioeconomic and physician-patient educational factors may contribute to a higher mortality rate among this group – over two times greater than that of Caucasian American males.

At present the most commonly used to detection tools for prostate cancer are the serum prostatic specific antigen test (PSA) and a digital rectal examination (DRE). These complementary tests provide physicians with an indication of whether to proceed with biopsy for a definitive pathological diagnosis. Despite ongoing disputes regarding the effectiveness of PSA screening as an indicator for prostate cancer, a superior alternative test as yet to become available for men at risk.

The American Urological Association (AUA) emphasizes the value of early detection and that sheared decision-making should not be overlooked and that shared decision making should be integral to screening decisions. The AUA urges individuals to personally assess, with their physicians, whether a PSA screen is necessary. Emphasis should be placed on the proper education of African American men who are at increased risk for the disease, as well as on their participation in repeated screening practices for the earliest possible detection of prostate cancer.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Albala: Today, two notable trials have investigated the value of PSA screening and reducing prostate cancer mortality, each yielding slightly different results.  The Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial of valuated over 75,000 subjects from 10 US healthcare centers; male participants were stratified and randomized according to center and age. This study did not find screening to be associated with mortality rate; cancer incidence and mortality among the screening group were found to be 1.17 and 1.11 times that of the control group respectively.

The European randomized study of screening for prostate cancer in (ERSPC) randomized 162,243 subjects from seven healthcare centers and various countries into 2 groups: screening and control. A serum PSA measurement was the primary screening methodology employed by the participating sites; DRE and transrectal ultrasonography were utilized as secondary test in some countries. Indication for biopsy following screening varied slightly among the sites as well. Despite the observed decrease in mortality (25%), the investigators did conclude a high risk of over-diagnosis was associated with this reduction; they reasoned that 1,410 additional men would need to be screened and 48 extra cases treated to prevent one additional prostate cancer death.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Albala: Numerous studies have sought to discover any baseline biological differences relating to prostate cancer risk among men of various racial backgrounds. Given the recent findings and increasing knowledge about the possible discrepancies between PSA serum levels and prostate cancer invasiveness for distinct individuals, it is recommended that multiple patient aspects be considered before administering a biopsy following a PSA test. The AUA warns against recent publish skepticism surrounding the current methods of prostate cancer screening and urges individuals to personally assess, in conference with their physicians, whether a PSA screen is necessary. Late detection of prostate cancer for African American populations is a legitimate issue of healthcare access, the burden of which can be lessened by more active discussion with and education of patients by family practitioners.

We urge primary caregivers to be forward and open about prostate cancer screening with their patients of all racial and family backgrounds. Additionally, emphasis should be placed on the proper education of African American men who are at increased risk for the disease, as well as their participation in repeated screening practices for the earliest possible detection of prostate cancer.

Citation:

PSA Screening for the African American Male: When and Why?

Tyler A. Luthringer, Ilija Aleksic, Vladimir Mouraviev, and David M. Albala.
Journal of Men’s Health. November 2013, 10(3): 86-90. doi:10.1089/jomh.2012.00026