Black Men Should Be Screened for Prostate Cancer at Younger Age

Newswise — The American Cancer Society guideline to begin screening African-American men at an earlier age than other races is appropriate, according to a new study in the December 2003 issue of the International Journal of Radiation Oncology·Biology·Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology.

In 2002, adenocarcinoma of the prostate was the most common cancer diagnosed in men. As the incidence of prostate cancer has increased, so has the difference in diagnosis rates between Caucasians and African-Americans. Additionally, the mortality rate of African-Americans is double that of Caucasians.

In 1997, ACS updated screening guidelines for the early detection of prostate cancer to include the following: "Men in high-risk groups, such as those with strong familial predisposition, or African-Americans, may begin screening at a younger age (i.e. 45)." This study aimed to determine whether African-American men diagnosed with prostate cancer in the prostate-specific antigen (PSA) era differed in initial presenting serum PSA levels (iPSA) compared to Caucasian men and to determine any trends in iPSA in African-American and Caucasian men between the time periods before the guideline change (1990-1996) and after (1997 to 2001).

Of the 4,519 patients with prostate cancer initially seen, 2,332 patients qualified for this analysis. Among these patients, there were 1,968 Caucasian and 364 African-American participants. Between 1990 and 2001, mean iPSA has slowly changed. There was a significantly higher iPSA level among African-American men compared to Caucasian men for both time periods of the study. Analysis revealed that African-American men presented with about 36 percent higher PSA level at presentation than Caucasian men for the first time period and 13 percent higher PSA level at presentation than Caucasian men for the second time period. Taken as a whole, this analysis suggests that the difference in iPSA between African-American men and Caucasian men diminished in 1997 to 2001 compared to the earlier time period.

Age at diagnosis was significantly younger for African-American men compared to Caucasian men. This effect was seen in both time periods. Between 1990 and 1996, African American men were 2.5 years younger than Caucasian men at the time of diagnosis. After 1996, the age gap increased to 3.1 years.

"The overall decline in initial PSA levels in both racial groups is good news as it shows that patients have become more aware of the disease and are coming to us when their cancer is most treatable," said Charlie Pan, M.D., the lead author of the study and a member of the Department of Radiation Oncology at the University of Michigan in Ann Arbor, Mich. "The racial differences in initial PSA levels observed in the study prove that African-American men are more susceptible at an earlier age to this disease and should continue to be screened at a younger age than Caucasians, as recommended by the American Cancer Society in its screening guidelines."

The American Society for Therapeutic Radiology and Oncology is the largest radiation oncology society in the world, with 7,500 members who specialize in treating patients with radiation therapies. As a leading organization in radiation oncology, biology and physics, the Society's mission is to advance the practice of radiation oncology by promoting excellence in patient care, providing opportunities for educational and professional development, promoting research and disseminating research results and representing radiation oncology in a rapidly evolving socioeconomic healthcare environment.