Evaluating Prostate-Specific Antigen Screening for Young African American Men With Cancer. (10th December 2021)

• Record Type: Journal Article
• Authors: Qiao, Edmund M; Lynch, Julie A; Lee, Kyung M; Kotha, Nikhil V; Nalawade, Vinit; Voora, Rohith S; Qian, Alexander S; Nelson, Tyler J; Yamoah, Kosj; Garraway, Isla P; Stewart, Tyler F; Parsons, J Kellogg; Rose, Brent S
• Is Part Of: Journal of the National Cancer Institute. Volume 114:Number 4(2022)
• Page Start: 592
• Page End: 599
• Publication Date: 2021-12-10
• Subjects: Cancer -- Periodicals; Cancer -- Research -- Periodicals; 616.994
• DOI: 10.1093/jnci/djab221
• Languages: English
• ISSNs: 0027-8874

Abstract

Abstract: Background: Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients. Methods: We identified African American men aged 40-55 years, diagnosed with prostate cancer between 2004 and 2017 within the Veterans Health Administration. Inverse probability of treatment-weighted propensity scores were used in multivariable models to assess PSA screening on PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on prostate cancer–specific mortality (PCSM), with noncancer death as competing events. All statistical tests were 2-sided. Results: The cohort included 4726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1057 (22.4%) with no PSA screening prior to diagnosis. Compared with no screening, PSA screening was associated with statistically significantly reduced odds of PSA levels higher than 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49 to 0.63; P < .001), Gleason score of 8 or higher (OR = 0.78, 95% CI = 0.69 to 0.88; P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39 to 0.64; P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36 to 0.76; P < .001). Primary care provider visits displayed similar effects. Conclusions: Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.