Prostate Cancer Screenings Can Fail to Detect Early Disease in African-Americans

Prostate Cancer Screenings Can Fail to Detect Early Disease in African-Americans
A new study in the Journal of Urology reveals that African-American men have an antigen profile that differs from Caucasians, and the current prostate-specific antigen (PSA)-based screening may exclude men in this racial group who should be included in prostate cancer surveillance programs. For early stage low-grade prostate disease, surveillance of disease progression — so-called watchful waiting — is common practice. Screening PSA levels to identify and place men on watchful waiting have reduced death from prostate cancer by 40% since screening programs were initiated in the 1980s. PSA is also the only available test to select subjects for prostate biopsy with unremarkable results from a digital rectal examination. In this study, however, Dr. Oleksandr N. Kryvenko from the University of Miami, and colleagues show that current PSA cut-off values are not suitable for African-Americans. The study included 348 whites and 66 African-Americans, and compared clinical presentation, pathological findings, PSA, PSAD, and PSA mass (PSAM) — an absolute amount of PSA in a patient's circulation — between these two groups. The study showed that when comparing men with same-size tumors, African-Americans produced less PSA and had a lower PSA density (PSAD) score than Caucasians. Likewise, the groups had equal levels of serum PSA and PSAM despite the significantly larger prostates, indicating more advanced disease, found in African-American men. The team concluded that all other factors being equal, African-Americans have on average a 20% lower PSAD than Caucasians. "When low volume and low-grade cancer is detected, especially in older individuals, the decision between active surveillance and definitive therapy must be made. Because PSAD was
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