(UroToday.com) The 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between January 25th and 27th was host to a prostate cancer poster session. Dr. Isla Garraway presented the Prostate Cancer Foundation (PCF) screening guidelines for prostate cancer in Black men in the United States.
It has long been demonstrated that Black men in the United States are among the highest-risk populations for being diagnosed with and dying from prostate cancer. Black men are also more likely to be diagnosed at a younger age and harbor more aggressive disease. However, since 2011, PSA testing and biopsy rates have shown a steeper decline among Black men.
As such, the objective of this study was to assemble a diverse, multidisciplinary panel of experts representing primary care, urology, medical oncology, and radiation oncology to conduct a comprehensive literature search and review that addresses key questions relating to prostate cancer screening in Black men. These questions/topics include shared decision-making as to:
- When screening should start
- Frequency of PSA testing
- When PSA testing should end
- What additional risk factors should be considered?
The objective of this multidisciplinary analysis was to generate a set of practical patient-centered guidelines for Black men that complement existing national guidelines focused on early prostate cancer detection.
To this end, the Prostate Cancer Foundation held bi-monthly meetings with the multidisciplinary panel and patient advocates. Key questions and Population, Intervention, Comparator, Outcome (PICOs) guided a comprehensive literature search and review in compliance with the Preferred- Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Upon summarizing the available evidence, the assigned methodologist and the Prostate Cancer Foundation panel chairs formulated guideline recommendations based on key questions, which were subsequently presented to all expert panel members. Consensus was defined as ≥80% agreement. Dissenting opinions/counterpoints were noted. 
The six identified key questions, along with the PCF statements of recommendations, are summarized in the table below:
Following a review of the best available evidence, the PCF expert panel overwhelmingly supported the recommendation for a risk-adapted PSA screening approach for Black men in the United States, in order to reduce the rates of metastases and death from prostate cancer. The panel agreed that PSA screening discussions should be initiated at age 40 and baseline PSA testing should be performed prior to age 45, after which regular PSA testing can be continued (up to an annual basis, depending on the baseline PSA value and other health factors). Given the currently available evidentiary literature, and while additional studies could further clarify the impact of PSA screening on Black men, the panel argued that the current evidence warrants revisiting current recommendations for early prostate cancer detection in Black men from other national guideline groups.
Presented by: Isla Garraway, MD, PhD, Professor and Director of Research in Urology at the David Geffen School of Medicine at UCLA, Los Angeles, CA
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, San Francisco, CA, January 25th – January 27th, 2024
Related content: Prostate Cancer Foundation's Guidelines for Black Men in the US - Isla Garraway