Trends in PSA, age and prostate cancer detection among black and white men from 1990‐2006 at a tertiary care center

Abstract

BACKGROUND: Prostate cancer is the most frequently diagnosed malignancy in men in the United States, with even higher prevalence and death rates among black men. The authors sought to compare trends in prostate-specific antigen (PSA), age, and prostate-cancer detection among black and white men in our region during a 16-year period. METHODS: This was a retrospective study of patient archives between 1990 through 2006. Data collection was accomplished by examining patients' charts and electronic medical records. Data from 5570 patients, of whom 911 were black, were analyzed statistically by testing and comparing parameters over time. RESULTS: During this 16-year period, mean age at the time of initial diagnostic prostate biopsy did not change in either group, despite what we had believed about the effects of patient education and screening campaigns. However, prostate-cancer detection rates did decrease during the time period studied. Over time, the authors also observed significant decreases in the sensitivity and specificity of PSA as a screening tool. Indeed, analysis of more recent cases demonstrated a positive predictive value comparable to a coin toss. While Gleason scores remained relatively stable over time, reporting of prostate intraepithelial neoplasia (PIN) and inflammation increased. CONCLUSIONS: Using lower PSA thresholds, promoting younger screening age, and increasing efforts to educate the public have not seemed to influence age at time of diagnostic testing, which may reflect other factors such as usefulness of screening, physician referral patterns, patient compliance, and other sociodemographic issues. The usefulness of PSA as a screening tool appears to be diminishing. Cancer 2010;116:3910-5.

African American Women’s Involvement in Promoting Informed Decision-Making for Prostate Cancer Screening Among Their Partners/Spouses

“…Many prostate cancers are slow growing and do not require active treatment ( Hao et al, 2011 ). Over-diagnosis and over-treatment of the disease are associated with issues that significantly impact a man’s quality of life (e.g., incontinence, improper bowel function, and erectile dysfunction) ( Barry, & Mulley, 2009 ; Potts, Lutz, Walker, Modlin, & Klein, 2010 ; Smith et al, 2011 ). Consequently, the U.S. Preventive Services Task Force (UPSTF) recommends against routine screening of all men at average risk for prostate cancer ( Chou et al, 2011 ).…”

High grade prostate intraepithelial neoplasia (PIN) is a PSA-independent risk factor for prostate cancer in African American men: Results from a pilot study

“…Based on the observed results, the authors hypothesized that the 40-49 years age range may be the beginning of prostate cancer racial disparity, as more AAM that harbor PIN go on to develop cancer. In concordance with these data, Potts et al [12] reported that AAM were more likely to be diagnosed with PIN, compared with their White counterparts (OR, 1.44; P < .0001), even after adjusting for PSA levels. Our results are not only in agreement with these published data, but also provide two provocative and novel, potentially high-impact findings.…”

“…PIN shares many histological characteristics with prostate cancer shy of the stromal invasion [8], and the volume and extensiveness of PIN positively correlate with the Gleason score, providing convincing evidence that PIN is an immediate prostate cancer precursor. Studies suggest that the prevalence of PIN is higher in AAM [9-12], and that AAM with PIN are more prone to the development of aggressive, clinically significant cancer [13]. Finally, PIN seems to be a risk factor for biochemical recurrence following the definitive treatment in AAM [13].…”

Chemoprevention in African American Men with Prostate Cancer

“…51 Significantly higher prevalence rates of HGPIN have been reported in African American men aged 40 to 49 years compared with white men (46% vs 29%, respectively), suggesting that this early-onset age range may represent the beginning of a racial disparity related to prostate cancer; this is because more African American men with HGPIN go on to develop prostate cancer. 52 In concordance with these data, Potts et al 53 reported that African American men were more likely to be diagnosed with prostatic intraepithelial neoplasia compared with white men, even after adjusting for PSA levels.…”