Abstract ED04-03: Prostate cancer screening (testing) controversy and its impact on African American men
Authors: Powell Isaac J. 
Published: May 2015

In May 2012, the United States Preventive Service Task Force (USPSTF) recommended against PSA screening of healthy men.7 This recommendation was based primarily on the PLCO (Prostate, Lung, Colon and Ovarian) prospective randomized clinical trial which reported no decrease in mortality rate in the screened arm and therefore no PSA screening benefit. This recommendation applied to men in the U.S. population that did not have symptoms that were highly suspicious for prostate cancer, regardless of age, race, or family history. Only 4% of the study population was AAM.8 The PLCO results, however, understated the impact of screening on PCa mortality due to a high contamination rate in the control arm. During the study, 52% of controls underwent opportunistic PSA testing. In addition, Pinsky et al. reported that 85% of controls had a PSA test before or during the study; only 15% of PLCO controls never had a PSA test.9 Furthermore, a seven year median follow-up time was premature for estimating an impact of PSA screening on mortality, as the study was designed to report mortality rate comparison after 13 years.8

The 2013 AUA (American Urological Association) PCa Guidelines strongly recommended shared decision-making for men age 55 to 69 years, at intermediate risk, who were considering PSA testing.10 The AUA panel did not recommend routine testing in men between ages 40 to 54 years at average risk. The panel further commented “for men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualized and discussed with their doctor.” This statement was based on results from the Updated European Randomized Study of testing for Prostate Cancer (ERSPC) that demonstrated a 31% reduction in mortality in the PSA testing arm at 9 years median follow-up.11 This trial included European men only, thus it did not directly apply to AAM. The AUA guideline was inadequate and provided no clear direction or guideline for AAM. Thus, it is necessary to provide the most available scientific data to evaluate the benefit of PSA testing of AAM younger than 55.

Level 1 scientific evidence may not be achievable in this country because of the potential for high PSA testing contamination levels, similar to those reported for PLCO, in any future clinical trial of PSA testing. Therefore, other scientific evidence with reasonable and achievable endpoints must be considered. We hypothesize that early PSA testing and the reduction and/or elimination of racial disparity in prostate cancer survival among AAM (a high risk group) compared to EAM (an intermediate risk group) strongly supports the use of early PSA testing in AAM. We will present data from the pre-PSA, and current PSA era to demonstrate the reduction and elimination of PCa racial disparity in overall survival. Survival analyses are utilized to test the efficacy of therapies and therefore should be justified to test the utility of clinical markers between high and intermediate risk populations.

Citation Format: Isaac J. Powell. Prostate cancer screening (testing) controversy and its impact on African American men. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr ED04-03. doi:10.1158/1538-7755.DISP13-ED04-03