medwireNews: A cohort study has found a significant association between annual prostate-specific antigen (PSA) screening and a reduced risk for prostate cancer-specific mortality (PCSM) among non-Hispanic Black, but not White, men.
The finding suggests that “more intensive screening protocols may benefit Black patients,” say the researchers, and they add: “These results may be biologically plausible because a shorter screening interval may be valuable for detecting aggressive disease, which is more common in Black men.”
The team stresses, however, that “[f]urther research is needed to identify appropriate populations and protocols to maximize the benefits of PSA screening.”
Brent Rose and colleagues from the University of California, San Diego in La Jolla, USA, analyzed data from the US Veterans Health Administration Informatics and Computing Infrastructure on 45,834 men aged 55–69 years who self-identified as non-Hispanic Black (31%) or non-Hispanic White (69%) and were diagnosed with intermediate-, high-, or very high-risk prostate cancer in 2004–2017.
In multivariable analysis, the PSA screening rate – defined as the percentage of years in which one or more PSA screens were conducted in the 5 years before diagnosis – was significantly associated with a reduced risk for PCSM, with a subdistribution hazard ratio (sHR) of 0.57.
The reduction in risk was comparable for Black and White men, with respective sHRs of 0.56 and 0.58, report Rose and team in JAMA Oncology.
They also evaluated the impact on PCSM risk by frequency of screening, finding that annual PSA screening (one or more screens in each of the 5 years before diagnosis) was associated with a significant risk reduction relative to some screening (one or more screens in the 5 years preceding diagnosis) in Black participants, with an sHR of 0.65.
By contrast, there was no such association among White participants (nonsignificant sHR=0.91).
The cumulative incidence of PCSM at 120 months was 4.7% among Black men who underwent annual screening and 7.3% for those receiving some screening, while among White men the cumulative rates were 5.9% and 6.9%, respectively.
Discussing the results, the authors highlight that “[a] study by some of us recently demonstrated that screening was associated with reduced PCSM among younger Black veterans (age 40-55 years),” and the current study “suggests that these findings are also applicable to older Black men.”
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