Prostate cancer screening consists of something called the prostate-specific antigen (PSA) blood test, which measures the amount of protein in the blood that’s produced by the prostate. Everyone assigned male at birth should begin PSA screening anywhere from age 40 to 50, depending upon their personal risk level for prostate cancer. Establishing a baseline PSA in midlife can help determine whether you will develop prostate cancer in the future and may inform how vigorously you should be monitored for prostate cancer throughout your adult life.
But a recent Henry Ford Health study found that for the same midlife baseline PSA level, Black men are more likely than white men to get lethal prostate cancer.
“Black men are twice as likely as white men to develop and die from prostate cancer – this we know,” says Firas Abdollah, M.D., a urologist at Henry Ford Health who led the study. “So we wanted to find out whether this baseline PSA screening worked for them in the same way it worked for white men – whether it could predict a lethal prostate cancer diagnosis in the future.”
Lethal prostate cancer is defined as someone who either dies from prostate cancer or who has metastatic prostate cancer, meaning it has spread to other parts of the body and is incurable. In the study, Dr. Abdollah singled out those with lethal prostate cancer, as sometimes prostate cancer can be very slow growing. Those with slow-growing prostate cancer may never die from it.
Comparing Midlife Baseline PSA Levels with Future Prostate Cancer Risk
Included in the study were 112,967 men aged 40 – 59 years who underwent PSA testing at Henry Ford Health; 27% of whom identified as Black. For white men who had midlife baseline PSA values above average, the risk of developing lethal prostate cancer ranged from 3.0- to 5.1-fold higher, depending on their age category. For Black men, that risk ranged from 4.2- to 9.8-fold higher.
Prostate Cancer Care
“Our findings indicate that for the same baseline PSA and within the same age category, Black men have a much greater risk of developing future lethal prostate cancer than white men,” says Dr. Abdollah. “This means we should be even more cautious with Black men. It leads to questions like, 'how should we change our screening and follow up? Should we use less than median PSA levels for Black men when deciding whether to do intense prostate cancer screening?' Being more aggressive with screening or changing our protocols based on the baseline PSA can hopefully result in better outcomes for Black men in the future.”
Why Are Black Men More Likely To Get Lethal Prostate Cancer?
Why Black men are more likely to develop aggressive prostate cancer is the question that numerous studies are trying to answer – and research shows that it is likely overwhelmingly due to social determinants of health.
“There are prostate cancer mutations specific to Black men, but no strong evidence to show they’re related to a higher incidence of mortality,” says Dr. Abdollah. “We can’t exclude the role of access to healthcare. Black men are less likely to live near healthcare centers of excellence, less likely to have health insurance and more likely to experience healthcare bias. All of these factors can play a significant role in someone’s health outcome.”
While more research is being done to understand racial disparities in prostate cancer outcomes, it’s so important to see a doctor to get regular PSA screenings. The American Cancer Society recommends that Black men begin prostate cancer screening at age 45 if they don’t have a family history of prostate cancer or at age 40 if they do have a family history of prostate cancer. And if you are experiencing symptoms of prostate cancer – like frequent urination or blood in your urine – you should see a primary care doctor right away.
Reviewed by Firas Abdollah, M.D., a urologist who sees patients at Henry Ford - Cancer in Detroit, Henry Ford Hospital and Henry Ford Medical Center – Sterling Heights. Dr. Abdollah specializes in robotic surgery for prostate cancer (as well as kidney, adrenal and bladder cancer) and is the vice-chair of academics and research for the department of urology. He has published extensive research on the impact of race in prostate cancer.
