In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States.
A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.
These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
NEJM evidence. 2024 Apr 23 [Epub]
Isla P Garraway, Sigrid V Carlsson, Yaw A Nyame, Jason L Vassy, Marina Chilov, Mark Fleming, Stanley K Frencher, Daniel J George, Adam S Kibel, Sherita A King, Rick Kittles, Brandon A Mahal, Curtis A Pettaway, Timothy Rebbeck, Brent Rose, Randy Vince, Robert A Winn, Kosj Yamoah, William K Oh
Department of Urology, David Geffen School of Medicine, University of California and Department of Surgical and Perioperative Care, VA Greater Los Angeles Healthcare System, Los Angeles., Departments of Surgery and Epidemiology and Biostatistics, Urology Service, Memorial Sloan Kettering Cancer Center, New York., Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle., Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford and Boston., Medical Library, Memorial Sloan Kettering Cancer Center, New York., Virginia Oncology Associates, US Oncology Network, Norfolk, VA., Martin Luther King Jr. Community Hospital and University of California, Los Angeles., Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC., Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston., Section of Urology, Medical College of Georgia at Augusta University and Charlie Norwood Veterans Affairs Medical Center, Augusta, GA., Morehouse School of Medicine, Community Health and Preventive Medicine, Atlanta., Sylvester Comprehensive Cancer Center, Miami., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston., Department of Medical Oncology, Dana-Farber Cancer Institute, Boston., Department of Radiation Oncology, University of California, San Diego., Department of Urology, University of Michigan, Ann Arbor., Massey Cancer Center, Virginia Commonwealth University, Richmond., Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL., Prostate Cancer Foundation, Santa Monica, CA.