ORLANDO – Tumors detected following prostate-specific antigen screening in black men aged 40-54 years had more favorable clinico-pathologic characteristics than those detected in black men aged 55-70 years, according to a study of more than 2,700 veterans.
The findings provide clinical support for the recommendation that black men who desire prostate cancer screening undergo prostate-specific antigen (PSA) testing at an earlier age than is suggested for white men – a recommendation based primarily on observed racial disparities in prostate cancer outcomes for men older than 50 years of age, Amanda Saltzman, Pharm.D., reported at the annual meeting of the American Urological Association.
Among the observed racial disparities in outcomes are higher tumor grade, greater likelihood of nonlocalized disease, and advanced-stage prostate cancer at diagnosis, as well as higher tumor volume in prostatectomy specimens, higher index PSA levels, younger age at diagnosis, lower likelihood of low-risk prognostic data, and higher mortality. However, it has been unclear whether earlier testing confers a survival benefit, she said.
In the current study, Dr. Saltzman and her colleagues sought to determine whether the diagnosis of tumors with characteristics associated with increased mortality was less likely in black men tested at ages 40-54 years, compared with those tested at ages 55-70 years, and compared with white men tested at ages 40-54 years in an "equal insurance coverage system," Dr. Saltzman of Louisiana State University, New Orleans explained during a press briefing at the meeting.
The men were part of a cohort of more than 231,000 otherwise healthy veterans aged 40-70 years who underwent PSA testing between October 2000 and September 2007. A total of 1,044 black veterans and 1,700 white veterans were diagnosed with prostate cancer. A total of 397 black men aged 40-54 years were compared with 647 black men aged 55-70 years and with the white veterans aged 40-54 years.
No difference was seen between the younger and older black cohort with respect to prebiopsy PSA. For example, 9.3% and 9.4% of men in the groups, respectively, had PSA greater than 20 ng/mL.
"When we looked at our young black cohort and our white cohort, however, there was a statistically significant difference, with our blacks having a higher index PSA [9.3% younger blacks vs. 6% whites had PSA greater than 20 ng/mL]. When we looked at biopsy Gleason sums, there was a significant difference between our older blacks and our younger blacks, with our older blacks tending to have higher Gleason scores than the younger blacks [15% vs. 12% had scores greater than eight, for example]," Dr. Saltzman said.
There was no difference between the young black veterans and the white veterans in Gleason scores, and no difference between any of the groups with respect to tumor stage.
In the older blacks, there was a nonsignificant trend toward higher risk, compared with younger blacks.
"This trend persisted ... with our younger black men tending to be at higher risk than our white veterans," she noted.
"PSA testing of black men younger than age 55 provides a benefit specifically with respect to Gleason score at diagnosis. We know that Gleason sum strongly predicts disease-free survival in men with clinical localized disease. In contrast to prior general population studies, we did not observe any racial disparities with respect to clinical stage, tumor grade, or D’Amicorisk stratification for prostate cancer in veterans aged 40-54, so our equal insurance coverage seems to have eliminated some of the previously reported disparities," she said, adding that she and her colleagues hope to further explore whether earlier testing reduces prostate cancer deaths in blacks, and whether equal insurance coverage and equal access to screening and detection tools eliminates previously reported racial disparities in prostate cancer death.
The current findings provide the first evidence to support the current recommendations for screening at an earlier age in black men, she concluded, adding: "I would definitely advocate for screening black men early. The specific age is unclear, but certainly before age 55."
Dr. Saltzman reported having no disclosures.