For years, experts have flip-flopped over whether doctors should routinely screen men for prostate cancer using the prostate-specific antigen, or PSA, test.
At first, nearly every guy over 50 received one. Then, back in 2012, the U.S. Preventive Task Force (USPTF) recommended against it for preventive screening. Most recently, the USPTF proposed a change to their recommendations, saying that the decision to screen for men ages 55 to 69 should be determined on a case-.-case basis between patient and doctor.
But that still leaves a gray area, especially considering this: Black men are 28 to 56 percent more likely to develop preclinical—or asymptomatic—prostate cancer than men of other races, found a just-published study in Cancer.
More importantly, the researchers found that for black men, the risk of progression to advanced disease at the time of diagnosis is 44 to 75 percent higher compared to the general population. That means . the time many black men get diagnosed, the cancer has already spread, making it more difficult to treat.
What Black Men Need to Know About Prostate Cancer
We’ve known for a long time that prostate cancer disproportionately affects black men. In fact, the rate of prostate cancer is about 60 percent higher than in white men, and their chances of dying from it are two to three times higher, too.
The higher rates of prostate cancer in black men isn’t new, but this paper also shows that their prostate cancer is also more likely to be aggressive and to grow faster, says lead study author Ruth Etzioni, Ph.D., a principal investigator at Fred Hutchinson Cancer Research Center.
The jury’s still out on why this disease develops in African Americans at such a high rate. Unlike other cancers with modifiable risk factors—like smoking and lung cancer, sunlight and skin cancer, and alcoholism and liver cancer—experts only know of three fixed risk factors for prostate cancer: age, race, and family history.
What the Guidelines Say About Race and Screening
You can’t change your age, race, or family history. But you can control when you get screened.
So does this mean black men should approach PSA testing differently?
Surprisingly, there’s no formal guidance on that issue. The Task Force states they’re unable to create separate guidelines for African American men because no “direct evidence” shows that screening earlier or more often would benefit black men more than the general population.
“There’s plenty of circumstantial and clinical evidence,” says Men’s Health urology advisor Larry Lipshultz, M.D. “But the Task Force is organized to make recommendations based only on established literature, and there’s no study for them to cite.”
But that doesn’t eliminate the need for a separate approach to screening for high-risk men.
“I understand why the Task Force won’t create separate recommendations, but I wish they would, because this is a population in which the disease is a big burden and they need formal guidance that supports them,” Dr. Etzioni says.
In fact, after analyzing the available literature on prostate cancer incidence, course of disease, outcomes, genetic differences, and social barriers, scientists concluded in a 2016 BMC Urology review that separate prostate cancer screening guidelines would be “greatly necessary to help save the lives of African Americans.”
So What Do Experts Say About PSA Testing For Black Men?
The aggressive nature of prostate cancer in black men justifies earlier screening, and offers the chance to catch the cancer before it spreads outside the prostate or grows to an advanced stage, Dr. Etzioni says.
So while there is no official caveats to the guidelines for African Americans, that doesn’t necessarily mean you shouldn’t get screened earlier.
The important thing is that black men are informed patients and that they know they’re at greater risk, Dr. Lipshultz says.
He recommends screening once a year starting at age 45, and twice a year if results show a rise in PSA levels. But don’t panic over the results.
“Prepare to be calm if you’re diagnosed,” Dr. Etzioni says. “Even among black men, many prostate cancers are low-risk.” That means most cancers aren’t aggressive, and may not even require treatment. In fact, among black men who develop prostate cancer, only about 10 percent of them will progress to an advanced stage . the time they’re diagnosed.
.: Men’s Health
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