BackgroundIn 2012, the United States Preventative Services Task Force issued new guidelines recommending that male U.S. residents, irrespective of race, no longer be screened for prostate cancer. In African American men, the incidence of prostate cancer is almost 60 % higher and the mortality rate is two to three times greater than in Caucasians. The purpose of this study is to reduce African American men's prostate cancer burden by demonstrating they need separate screening guidelines.MethodsWe performed a PubMed search using the keywords: African American, Prostate cancer, Outcomes, Molecular markers, Prostate-specific Antigen velocity, PSA density, and to derive data relevant to our hypothesis.ResultsIn our literature review, we identified several aspects of prostate cancer that are different in Caucasian and African American men. These included prostate cancer incidence and outcome, the clinical course of the disease, serum PSA levels, genetic differences, and social barriers. It's also important to note that the USPSTF guidelines were based on two studies, one of which reported that only 4 % of its participants were African American. The other did not report demographic information, but used participants from seven European countries with small African American populations.ConclusionGiven the above, we conclude that separate prostate cancer screening guidelines are greatly necessary to help save the lives of African Americans.

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Background: The United States Preventive Task Force recommended against the prostate-specific antigen (PSA)-based screening for prostate cancer in 2012, a recommendation that applies to all American men. African-American men, however, have the highest incidence of prostate cancer and are more likely to be diagnosed with an advanced stage and poor prognostic-form of prostate cancer. The incidence of prostate cancer is almost 60% higher, and the mortality rate is two- to three-times greater among African Americans than that of Caucasian men1. The Veteran's Health Administration is an unbiased, race-color blind, equal and open access, single-payor, government run health care system2. Yet, due to complex interactions of ethnicity, biology, comorbidities, environmental interactions, as well as social causes, African-American veterans are present with more aggressive disease and carry a worse outcome. Therefore African-American veterans need specific interventions to improve prostate cancer outcomes; i.e., improve survivals and quality of life. We hypothesize that by developing specific and structured prostate cancer screening recommendations, we can improve the overall prostate cancer outcomes among African-American veterans. Methods: We performed a PubMed search using the keywords: African American, African American veterans, Prostate cancer, Outcomes, Molecular markers, Prostate-specific Antigen velocity, and PSA density to derive data relevant to our hypothesis. Results: 1. Men over the age of 65 are most susceptible to prostate cancer, and the average age of veterans is 582. So, they are at a nearly optimal age for preventative prostate cancer screening. 2. The USPSTF guidelines were based on two studies, and one of these studies reported that only 4% of its participants were African American. So, it is inappropriate to use the same guidelines for African American veterans. 3. Several aspects of prostate cancer are different between African Americans and Caucasians. These differences include prostate cancer incidence and outcome, genetic differences, comorbidity, PSA levels, social barriers, and course of the disease. 4. Prior to the new USPSTF guidelines, African American veterans were just as likely as white veterans to undergo PSA testing3. 5. Among the diseases linked to comorbidity with prostate cancer, cardiovascular disease is the most frequent. Hence, the leading cause of death in both the African-American population and the African-American veteran population is cardiovascular disease.2 Conclusion: 1. Because there is no cure for metastatic prostate cancer, early diagnosis and intervention for African-American veterans will lead to saving lives; specific guidelines for prostate cancer will be very beneficial. 2. This will also decrease the costs of treating recurrent and metastatic disease and conserve the resources of the VA Health System. 3. Because the Veterans Health System is equal access, it is an optimal environment to test different prostate cancer screening guidelines for African Americans. 4. Specific draft guidelines will be presented. References: 1. Shenoy D, Packianathan S, Chen AM, Vijayakumar S. Do African-American men need separate prostate cancer screening guidelines? BMC Urology. 2016;16:19. doi:10.1186/s12894-016-0137-7. 2. Veterans Health Administration. Veterans Health Administration. http://www.va.gov/health/. Published June 21, 2016. Accessed June 23, 2016. 3. Hudson MA, Luo S, Chrusciel T, et al. Do Racial Disparities Exist in the Use of Prostate Cancer Screening and Detection Tools in Veterans? Urologic oncology. 2014;32(1):34.e9-34.18. doi:10.1016/j.urolonc.2013.01.003. Citation Format: Arthi Gadum Reddy, Divya Shenoy, Satya Packianathan, Shankar Giri, Srinivasan Vijayakumar. Do African-American veterans need distinct “Prostate Cancer Screening Guidelines” to overcome outcome disparities? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C85.

Objectives: Prostate cancer is the one of the commonest cancers in American men and the second leading cause of cancer deaths. In 2012, the US Preventative Task Force recommended against the prostate specific antigen-based screening test for prostate cancer due to overtreatment of low-risk disease and lack of impact on outcomes. In the general population, African-American men have 60% higher incidence and 200-300% greater mortality rate from prostate cancer than Caucasian men. Additionally, many veterans have been exposed to chemicals that increase incidence of high-risk prostate cancer. Considering these factors, we examine whether or not it is appropriate to screen African-American veteran males for prostate cancer. Methodology: We performed a PubMed and Google Scholar search using pertinent terms, such as African-American veteran, prostate cancer, mortality, PSA density, molecular markers, and Agent Orange. The articles that were relevant to the clinical, molecular, social, and health policy aspects of the diagnosis and treatment of prostate cancer in African-American veterans were analyzed. The data was then summarized. Results: After surveying the literature, there were several areas where the African-American veteran population differed from their Caucasian counterparts: Incidence, clinical course, social differences, PSA levels, mortality rate, and molecular markers. A subset of the veteran population was also exposed to Agent Orange, which has been shown to increase the incidence of aggressive forms of prostate cancer. Lastly, the current USPTF guidelines recommending against prostate cancer screening were based on patient cohorts containing disproportionately low numbers of African-Americans, limiting their extension to the African-American veteran population. Conclusion: After reviewing and summarizing the literature, we contend that a need exists to develop and implement more targeted prostate cancer screening guidelines for African-American veterans.