Prostate Cancer's Aggressive Nature in Black Americans Suggests Need for More Personalized Screening

By: Patricia Inacio, PhD.

The higher rates at which black men are dying of prostate cancer may be linked to faster disease progression, according to a new study. The results suggest that African-Americans should be screened more frequently and at younger ages.

The study, “
Is prostate cancer different in black men? Answers from three natural history models,” appeared in the journal Cancer.

Black men in the United States are known to have a 60 percent higher risk of developing prostate cancer compared to white men — and their chances of dying from this cancer are twice as high.

Researchers at the University of Michigan’s Fred Hutchinson Cancer Research Center, and colleagues at Erasmus University in the Netherlands investigated why black men are particularly susceptible to prostate cancer. They used three models of prostate cancer incidence and prostate specific antigen (PSA) screening to estimate both disease onset and progression, based data collected from 1975 to 2000 by the Surveillance, Epidemiology, and End Results program of the 
National Cancer Institute.

They found that by their 85th birthday, 30 to 43 percent of black men develop what is called preclinical prostate cancer. That means the disease is already developing but patients show no 
symptoms — a risk that is 28 to 56 percent higher than in men of any other race.

Looking at preclinical disease in men across racial groups who go without screening, blacks showed a 35 to 49 percent prostate cancer 
diagnosis risk,  which was not that different from a 32 to 44 percent risk for men in the general population. However, their risk of progressing to advanced disease at diagnosis is 44 to 75 percent higher than men of other races.

“We found that the interval from getting preclinical cancer to being diagnosed is long — 10 years or more on average — and is similar in black and white men. But during that interval, cancers in black men tend to progress faster,” Dr. Ruth Etzioni, the study’s senior author, said in a 
press release. “What this means is that in developing screening policies for black men, it will be important to consider beginning screening them at an earlier age and potentially screening them more frequently than would be recommended by general population guidelines.”

Added Lauren Wallner, a PhD with the University of Michigan, and Dr. Steven Jacobsen of Kaiser Permanente Southern California, in an accompanying 
editorial: “As the evidence is accumulating that a ‘one size fits all’ screening approach to prostate cancer may not be what is most appropriate, it may be time for the conversation around PSA screening to really focus on more personalized approaches to screening in high-risk black men.”

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