PSA Screening Associated With Prostate Cancer–Specific Mortality Risk Reduction Among Black and White US Veterans

Findings from a cohort study published in JAMA Oncology highlighted an association between prostate-specific antigen (PSA) screenings and a reduction in prostate cancer–specific mortality (PCSM) among Black and White United States veterans.

Investigators highlighted that non-Hispanic Black patients had notable associations between PSA screening rates and lower PCSM risk (subdistribution HR [sHR], 0.56; 95% CI, 0.41-0.76; P = .001); this correlation was observed in White patients, as well (sHR, 0.58; 95% CI, 0.46-0.75; P = .001). In particular, annual screenings compared with some screenings were associated with a significant reduction in PCSM risk among Black patients (sHR, 0.65; 95% CI, 0.46-0.92; P = .02), although the same was not observed for White patients (sHR, 0.91; 95% CI, 0.74-1.11; P = .35).

“The results of this cohort study of U.S. veterans demonstrated that previous PSA screening was associated with reduced risk of PCSM among both non-Hispanic Black men and non-Hispanic White men,” the authors wrote. “Annual screening was associated with reduced PCSM risk among Black men but not among White men, suggesting that more intensive screening protocols may benefit Black patients. Further research is needed to identify appropriate protocols to maximize the benefits of PSA screening.”

Data for the retrospective cohort study were pulled from the United States Veterans Health Administration Informatics and Computing Infrastructure. To be included in the research, patients were required to be between the ages of 55 to 69 years with intermediate-, high-, or very high–risk disease.

A total of 45,834 patients were included in the study with a mean age of 62.7 years. Within that population, 31% of patients were non-Hispanic Black and 69% were non-Hispanic White. At a median follow-up of 77 months, Black individuals were more likely to be younger at diagnosis compared with White individuals (P = .001). However, the subgroup was not more likely to have regional or metastatic disease compared with their White counterparts. Screening rates were similar between groups. A total of 5.4% of the population had died due to prostate cancer and 4.4% died from other causes by 2007.

At a median follow-up of 120 months, cumulative incidence of PCSM among Black patients who underwent annual screening was 4.7% (95% CI, 2.9%-6.4%) vs 7.3% (95% CI, 6.5%-8.0%) among Black patients who did some degree of screenings. Moreover, in the White cohort, the cumulative incidence of PCSM was 5.9% (95% CI, 4.7%-7.0%) among those who received an annual screening vs 6.9% (95% CI, 6.4%-7.3%) for those who received some screening.

Reference

Sherer MV, Qiao EM, Kotha NV, et al. Association Between Prostate-Specific Antigen Screening and Prostate Cancer Mortality Among Non-Hispanic Black and Non-Hispanic White US Veterans. JAMA Oncol. Published online August 4, 2022. doi:10.1001/jamaoncol.2022.2970