Black men should start prostate-cancer screening at age 45

The old recommendation of beginning screening at age 55 doesn't catch the early cancers, a new study notes.

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Black men should consider prostate cancer screening at 45 years, rather than the recommended 55 years of age, according to a recent study led by researchers from UW Medicine and Fred Hutch Cancer Research Center. The study was published recently in the Journal of the National Cancer Institute.  

“The study provides us evidence to support a personalized screening recommendation for Black men, who are more likely to be diagnosed at younger ages and with more aggressive disease," said Dr. Yaw Nyame, a urologic oncologist at the University of Washington School of Medicine. "We found that screening at age 45 and testing every year until age 70, decreased deaths from prostate cancer compared to current screening practices without increasing the number of over-detected prostate cancer cases."

Black men in the U.S. were about 60% to 80% more likely to be diagnosed with prostate cancer, and twice as likely to die from prostate cancer compared to men of other races in the U.S.

“If there are tools are at our disposal that can help us reduce the burden of Black men dying from prostate cancer through earlier detection of their cancers, I think we should use them.  Our study shows that we have that tool in PSA testing,” he said.

The screening strategy recommended by the study “will improve benefit without increasing harm,” he said.

“The screening between 45 and 70 decreased the likelihood dying by about 30 percent, when compared with no screening at all," he added.

Screening rates are lower among Black men in general. A study this past year indicates the gap may have increased after the U.S. Preventative Services Task Force recommendation in 2012 advised against routine PSA screening. That recommendation was changed in 2018. Now the task force advocates for shared decision-making regarding PSA screening for men 55 to 69 years.

However the new recommendation does not provide guidance for high risk populations such as Black men and men with strong family histories of prostate cancer. 

Nyame hopes that this study will be part of a series that will support screening recommendations to decrease the disproportionate burden of prostate cancer among Black men and other high risk populations by organizations such as the U.S. Preventive Services Task Force and the American Academy of Family Practice.

Nyame also hopes his research will encourage doctors and patients to have conversations about prostate cancer screening. Sometimes those discussions simply do not happen. However, Nyame also recognizes that these screening recommendations do not address the many social barriers that drive the inequities observed in prostate cancer. The next stage of his work will engage and empower Black men to design the research studies and clinical interventions that will create better outcomes for their community. 

This work is being conducted as part of his research under a $500,000 CARES grant, which is seeking to understand how Black men in Washington state view prostate cancer in their own lives. The goal of the study is to identify unmet needs among Black men with regards to prostate cancer screening and treatment, and to design research studies and interventions to address them with help of community members. This patient- centered research approach places the community at the center of the entire process, from identifying what are important research isses to how to study and solve them.

“It is our hope that Black men will share their knowledge, attitudes, practices and experiences around early detection and treatment of prostate cancer, and join us in the development of durable solutions to eradicate the disparities of the disease,” he said.

The research team recently received a Department of Defense grant that will expand similar work nationally.  Nyame said that this award will support patient-centered research, with the goal of trying to understand a variety of social, economic and environmental factors which may affect the survival of Black men following prostate cancer treatment. 

“There is a lot of work that needs to be done to eliminate disparities in prostate cancer,” he said, “and I look forward to hearing from Black men about the ways we can start making progress towards better prostate cancer outcomes in our community.”


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