The higher prostate cancer death rates seen among black men in the United States may be due to a higher incidence of preclinical disease and a higher risk of metastatic progression, according to the results of a study published in Cancer.
“This study represents the first examination of how prostate cancer natural history must differ in black men to account for racial variation in patterns of disease incidence before and after the advent of PSA screening,” wrote researcher Ruth Etzioni, PhD, of the division of public health sciences at Fred Hutchinson Cancer Research Center in Seattle, and colleagues. “Our results provide quantitative information about the prostate cancer natural history that may support prior suggestions to explore different screening policies among white men and black men.”
According to the study, the incidence of prostate cancer in the United States among black men is about 60% greater than it is in white men, and their mortality rate from prostate cancer is more than doubled.
Using an updated reconstruction of PSA screening based on data from the National Health Interview Survey in 2005 and prostate cancer incidence data from the SEER program from 1975 to 2000, the researchers estimated three independently developed models of prostate cancer natural history in black men and in the general population.
Using this information, the researchers estimated that between 30% to 43% of black men develop preclinical prostate cancer by age 85. This risk is 28% to 56% higher than the general population, the models showed.
Among all men with preclinical disease onset, the risk of diagnosis was similar between black men and the general population. However, the researchers found that black men had a 44% to 75% greater risk for progression to metastatic disease by the time of diagnosis.
“Our findings motivate considering more intensive screening, eg, beginning earlier and/or screening more frequently, among black men than among the general US population,” the researchers wrote.
In an editorial that accompanied the study, Lauren Wallner, PhD, MPH, of the University of Michigan, and Steven Jacobsen, MD, PhD, of Kaiser Permanente Southern California, noted that the study’s findings imply that the risk/benefit trade-offs of PSA screening may be quite different for black men when compared with the general population.
“As the evidence is accumulating that a ‘one size fits all’ screening approach to prostate cancer may not be what is most appropriate, it may be time for the conversation around PSA screening to really focus on more personalized approaches to screening in high-risk black men,” they wrote.