Black men should start prostate cancer screening earlier

A study published in the journal NEJM Evidence recommends that Black men start talking with their doctors about prostate cancer screening as early as age 40, rather than 55, the currently recommended age. 

The Prostate Cancer Foundation screening recommendation comes from a group of 19 panelists: primary-care physicians, oncologists and patients (including two Black prostate cancer survivors).  Dr. Yaw Nyame, a UW Medicine urologist and affiliate investigator with the Fred Hutch Cancer Center, was on the panel and co-led the group writing the recommendations. 

Nyame hopes the report will provide impetus for other evidence-based screening guidelines by organizations such as the U.S. Preventive Services Task Force and American Academy of Family Physicians. 

Last year the panel reviewed 264 cohort studies focused on Black men. The evidence, they said, indicates prostate cancer develops three to nine years earlier in Black men compared with non-Black men. This suggests that Black men in their early 40s should discuss baseline PSA (prostate-specific antigen) testing with their clinicians. 

Based on this and other findings, the panel concluded that lowering the age for baseline PSA testing from age 50-55 to 40-45, followed by regular screening until age 70, could reduce prostate cancer deaths in Black men by 30% without substantially increasing overdiagnosis.

In 2021, Nyame was involved in a study that showed Black men would benefit from prostate cancer screening at age 45 years, rather than the recommended 55 years of age. Based on the newest review, Nyame agrees that the age should be even lower for high-risk populations such as Black patients. 

Currently, the U.S. Preventive Services Task Force recommends PSA screening be a topic of conversation with a physician for men ages 55-79. However, there are not PSA-based prostate cancer screening recommendations for Black men and other high-risk populations. These include men with a significant family history of prostate, breast, ovarian and colon cancers.

The prostate cancer statistics for Black men have been worrisome for over 50 years, Nyame noted. Affecting roughly 1 in 7 males in the United Stated over their lifetimes, it is the most common nonskin cancer among men,

For Black men, though, the U.S. incidence is about 60-80% higher than seen in men of other ethnicities, and the mortality rate is twice that of non-Black men.  For Black men in the Pacific Northwest, the news is equally troubling: Black men in this region are 60% more likely to die of prostate cancer than men of other races and ethnicities, according to earlier studies. 

In addition, the group recommended that a PSA test should be the first line of defense in screening for prostate cancer in Black men. Some urologists think that a digital rectal exam is an important screening method, but the panel stated that rectal examination is not an effective screen, Nyame said.

“It’s not an accurate screening tool. However, it is an important staging tool that should be left to the urologist and other specialists who are managing men with newly diagnosed prostate cancer,” he added.

Black men have a 120% higher rate of death from prostate cancer, compared to the general U.S. population. Not only do they have a higher risk of developing prostate cancer at a younger age, but they are also often diagnosed at a later stage of the disease, and with a more aggressive form of the cancer. 

“We cannot ignore the burden of prostate cancer among Black communities any longer,” he said. “This guideline, rooted in the best available evidence, gives us an opportunity to be action- oriented in reducing that burden.”

The recommendations by the Prostate Cancer Foundation were based in part by research done in partnership with Roman Gulati and Dr. Ruth Etzioni at the Fred Hutch Cancer Center.

For details about UW Medicine, please visit http://uwmedicine.org/about.