Should we be screening for prostate cancer among African Americans?

In a new lecture on the UroToday web site, Dr. Judd Moul of Duke University presents a passionate plea for better data on the relevance of PSA-based screening for risk of prostate cancer among African Americans. (We should immediately note that Dr. Moul is the chairman of the Scientific Advisory Board for this web site.)

For the best part of the past 20+ years, prostate cancer in the male African American community has been a matter of considerable interest to Dr. Moul since, among other things, he used to head up the Center for Prostate Disease Research at the Uniformed Services University of the Health Sciences in Washington, DC.

The key points that Dr. Moul makes in this lecture are basically as follows:

  • We know that African American men are at higher risk for both diagnosis with prostate cancer and death from prostate cancer than Americans in general and Caucasian Americans in particular.
  • We still do not know why this is the case, but it is probably a consequence of multiple factors, specifically inclusive of genetics, diet, lifestyle, and socioeconomics.
  • We do not have any meaningful data on the risks and benefits of PSA-based screening for prostate cancer in the African-American community specifically.
  • We do not know at what age we should be initiating testing for risk of prostate cancer among African Americans (although we suspect it is at a younger age than among Caucasians and Hispanics)
  • Even the most recent US Preventive Services Task Force recommendation on screening for prostate cancer makes no particular comment on the relevance of screening in African American men (or in other, specific groups of men known to be at high risk for prostate cancer) — primarily because we have no data that would allow the Task Force to do this.

The African-American population of the US now comprises just over 40 million people or 12.6 percent of the total population of ~ 320 million, and it is expected to rise to 13 to 14 percent by 2050. That is more than the total population of many entire countries around the world.

It is high time that we actually found out the degree to which we could be doing a better job of diagnosing and treating clinically significant prostate cancer in this group of high-risk patients — and to do this we need to know if PSA screening is a better option among this group of patients than it is among other races. And if it isn’t, we need to know that too!

7 Responses

  1. The last paragraph is very significant. Unfortunately it limits high-risk patients just to African-Americans. Data published elsewhere indicate that men with family history and men exposed to agent orange (not just Vietnam Veterans) are at even higher risk than African-Americans!

  2. Need to add: Half of men over 60 have prostate cancer, but most die of other causes. Also About 13% of the population is aged 55-64 and about 15% are 65 and older. If each of the men over 60 has just one son, then the number of men with family history also becomes very significant.

  3. Dear Wolfram:

    With respect, this article is entirely about risk in the AA community. The issues involved in defining risk associated with family history and exposure to Agent Orange are different and far more complex. For example, there is no absolute agreement to what is meant by “exposure” to Agent Orange, and with regard to “family history” how one chooses to define that also affects the data profoundly.

  4. Understood; didn’t mean to attack this article. Just wanted to point out that there are quite a few more men in a high-risk category that should possibly be screened as well.

  5. Yes, and the article duly notes that … see the fifth bullet. But it would be very hard to conduct such a trial with accuracy in either men with a family history of prostate cancer or men who had or thought they had been exposed to Agent Orange, for all sorts of reasons.

    In the former case, there would be many men who simply didn’t know that they had a father or a brother with prostate cancer (let alone a grandfather). And then the trial would need to be stratified by the type of cancer that the other family member had been diagnosed with, because we know that many, many men were diagnosed with and then treated for clinically insignificant prostate cancer between about 1990 and 2015.

    In the latter case, as I indicated above, we have no idea how much “exposure” to Agent Orange is clinically meaningful. Obviously you have not been meaningfully “exposed” if a truck passes your house one morning with an unopened can of Agent Orange in the back, and you certainly have been if you spent months loading the stuff onto planes during Operation Ranch Hand, but where’s the meaningful “break point”?

  6. Don’t really want to beat this to death, we generally agree.

    Family history? Even though somebody has clinically insignificant cancer, his offspring are still of higher risk.

    Agent Orange? Let’s start with the obvious cases.

    And, we really should add one more category: soldiers and men exposed to weapons and armors built with depleted uranium. Now, we are not talking about men in their 60s, but young men.

  7. Excellent article , Dr. Moul

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