Population-Based Screening for Prostate Cancer: Improved Outcomes in African American Men

Introduction

Excluding skin cancer, prostate cancer (PCa) is the most commonly diagnosed cancer among men in the United States. African American men have a higher incidence of PCa and are more likely to die from the disease than men of other race/ethnic populations. In 2002–2006, the age-adjusted PCa rate among Hispanic men was 15% lower than in non-Hispanic White men. However, uninsured Hispanic men with PCa are 3.75 times more likely to be diagnosed at a later disease stage, making it less treatable for cure. The reasons for these racial differences in PCa rates are not clear, but genetic factors as well as lifestyle differences such as diet, and selection bias in different screening practices may be important. Therefore, early PCa detection and prevention become especially important for African American and Hispanic men.

Abstract

INTRODUCTION

African American men have a higher incidence of prostate cancer (PCa) and are more likely to die from the disease than men of other race. The PCa incidence is lower in Hispanics but the stage of the disease is more advanced at the time of diagnosis.

OBJECTIVE

To examine how ethnic diversity affects PCa screening accounting for body mass index (BMI).

METHODS

From the population-based San Antonio Center for Biomarkers of Risk for prostate cancer (SABOR) cohort, 2358 participants comprising African Americans, Hispanics, and non-Hispanic White males 55 years or older were included for analysis. Area under the receiver operating characteristic curves (AUCs) of prostate-specific antigen (PSA), BMI-adjusted PSA, Prostate Cancer Prevention Trial (PCPT) PCa risk and high-grade PCa (Gleason ≥7) risk, and BMI-adjusted PCPT risks were compared among different ethnic groups.

RESULTS

The AUCs (95% confidence intervals) for PSA were .79 (.72, .86), .80 (.76, .84), and .90 (.85, .95) for Hispanics, non-Hispanic Whites and African Americans, respectively; for BMI-adjusted PSA, .79 (.73, .86), .79 (.76, .83), and .90 (.86, .95), respectively; for PCPT risks, .84 (.78, .9), .85 (.82, .88), and .92 (.88, .96), respectively; and for BMI-adjusted PCPT risks, .84 (.78, .90), .84 (.81, .88), and .93 (.89, .97), respectively.

CONCLUSIONS

In this cohort, the original and BMI-adjusted PCPT risk calculators performed significantly better for PCa detection than PSA alone for Hispanics and non-Hispanic Whites. All screening modalities, including PSA, performed markedly better for African Americans than for other race/ethnic groups.

Keywords

PCPT risk calculator, prostate cancer, ethnicity, body mass index