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Prostate Cancer Is More Likely In Black Men Than In White Men With The Same PSA Levels
While it's well established that Black men in the United States are more likely to develop prostate cancer and die of it than white men, a new study shows that Black males are also more likely to have prostate cancer at any PSA level.
Prostate-specific antigen (PSA) is a protein made by the prostate (a male sex gland), and levels can be higher in the blood of men who develop prostate cancer. This latest research indicates that Black men may face an increased risk of prostate cancer even at lower PSA levels than white men.
"We know Black men are at higher risk, but our study puts a number to that in terms of PSA value," says Julie Lynch, PhD, RN, an author of the study and the director of the precision medicine research team for VA Informatics and Computing Infrastructure (VINCI), a national resource center for the Department of Veterans Affairs (VA). "What was compelling to me was that a PSA of 4 in Black men is equivalent to a PSA of 13.4 in white men."
A High Cancer Risk at Lower PSA LevelsThe scientific paper, published November 6 in Cancer, a journal of the American Cancer Society, also highlighted that Black men with a pre-biopsy PSA of 4.0 ng/mL had a 49 percent risk of prostate cancer detected during their biopsy, compared with a 39 percent risk for white men with the same PSA level.
The American Cancer Society says that PSA levels often go above 4 when prostate cancer develops. Men with a PSA level between 4 and 10 are considered "borderline" and have about a 1 in 4 chance of having cancer.
Drawing on health data from about 75,000 Black and 208,000 white male veterans, Dr. Lynch and her colleagues further noted that prostate cancer was detected in the first prostate biopsy in 55 percent of Black men, compared with 43 percent of white men. The median age for the first biopsy was 63 for Black men and 65 for white men.
RELATED: Understanding Prostate Cancer Survival Rates
After various competing factors were taken into account, Black veterans were found to have a 50 percent greater chance of a prostate cancer diagnosis from their first prostate biopsy than white veterans.
Black men also had 30 percent greater odds of clinically significant aggressive prostate cancer.
"That's important, because you really have to treat aggressive cancer or you will die of it," says Lynch. "You don't want to overtreat, but there's a risk of undertreating, particularly with Black men."
A Call to Address Racial DisparitiesAn analysis published in 2022 estimated that Black men had about an 80 percent higher risk of prostate cancer and a 220 percent greater risk of death from it than white men.
For Lorelei Mucci, ScD, MPH, a professor of epidemiology with the Harvard T.H. Chan School of Public Health and the director of strategic research partnerships at the American Cancer Society, the research spotlights the urgent need to address the underlying racial disparities in prostate cancer and to better understand why PSA values indicating prostate cancer differ in Black and white men.
"Black men carry an undue burden of prostate cancer," says Dr. Mucci, who was not involved in the research. "The study calls out the importance of a possible lower threshold for biopsy in Black men, while also potentially diagnosing cancers earlier when cure is still possible."
In an effort to address the disparities and negative trends in prostate cancer incidence, Mucci and her collaborators at the American Cancer Society are working on a new initiative called IMPACT, or Improving Mortality Toward Prostate Cancer Together.
It's Lynch's hope that this latest data will empower patients to better evaluate their risk and make more informed decisions about PSA testing in discussion with their primary care provider.
If you're a Black man and your father or grandfather developed prostate cancer early, or died of it, she advises having early discussions with your primary care provider about whether PSA screenings at a younger age and more frequently is a good idea.
"This study illustrates how important it is for clinical guidelines to be informed by research conducted within diverse patient populations," says Lynch. "Thanks to advances in precision medicine, we now understand that cancer screenings should be informed by an individual patient's characteristics — including age, ancestry, family history of cancer, smoking history, other exposures, and perhaps even their genetic risk score for cancer."
Ask The Doctor: 'My Husband's Family Has A History Of Prostate Cancer And I Want Him To Get A Check Up — What's Involved?'
"My husband is in his 50s. With a history of prostate cancer in the family, I want him to get a check up, but he's apprehensive. What's involved in checking the prostate and what are the symptoms to look out for?"
Answer from Uro-Oncology Clinical Nurse Specialist, Karen Thomas, Beacon Hospital
One in seven men in Ireland will be diagnosed with prostate cancer in their lifetime. However, the good news is that there is a lot you can do. Just by knowing some important facts about risk and knowing when to act helps to allow for early detection. Age, genetics and ethnicity can all play a factor.
The cause of prostate cancer is unknown at present but there are factors that can increase risk. Prostate cancer is more likely to develop in older men. Only about 1 in 100 cases of prostate cancer are aged under 50.
Generally speaking, if you have a father or brother diagnosed with prostate cancer at a younger age, you are 2.5 times more likely to get prostate cancer yourself, compared to the average man.
Prostate cancer is more common in Black Caribbean and Black African men than in white or Asian men. Asian men have a lower risk than white men. This difference seems to be due to a mixture of inherited genes and environmental factors. When men move from a country where the prostate cancer risk is low to one where it is higher, their risk increases. For example, South Asian men living in Ireland have a higher risk of prostate cancer than men living in South Asia.
Prostate cancer grows slowly so years might pass by before symptoms become noticeable, so waiting for symptoms before you do anything is not the answer. Symptoms may include difficulty when urinating, things not feeling right during sex, aches or pains in your hips or pelvis, and bloody urine or semen. Be mindful that noticing symptoms does not automatically mean someone has prostate cancer. What it does mean, however, is that it's high time you check in with your doctor.
A PSA test is a routine blood test that measures the prostate-specific antigen protein in the bloodstream. Higher PSA levels could mean a range of conditions – including prostate cancer.
It's important to note that an elevated PSA level does not definitely mean someone has prostate cancer. In fact, age, prostate size, medications, infections, and other factors can affect PSA levels in a test. Your doctor is the best person to help you understand what your PSA level means. If your PSA test is high, your doctor will often refer you to a Urologist. The Urologist will talk to you about any urinary symptoms and will examine your prostate. They will often suggest you have an MRI scan of your prostate and they may then discuss if you need to have a prostate biopsy.
There are also things you can do to reduce the risk of prostate cancer. There is some evidence that choosing a healthy diet that's low in fat and full of fruits and vegetables may contribute to a lower risk of prostate cancer. Some studies show that men who are more physically active have a lower risk of getting prostate cancer.
In summary, if there is a family history and your husband is age 50 or above, it is always worthwhile to check in with his GP to keep on top of his general health and any concerns he or indeed you might have.
Have a question for the professionals you'd like answered? Get in touch with [email protected] with the subject headline 'Ask The Doctor'.
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