According to the American Cancer Society, Black men are one and a half times more likely to get prostate cancer than Caucasian men.
And if Black men develop prostate cancer, they are twice as likely to die from it than Caucasian men.
Such statistics have led to new guidelines recommending earlier PSA screenings for Black men.
KERA’s Sam Baker talked about this with Dr. Pat Fulgham, surgical director of oncology at Texas Health Dallas and chairman of the hospital’s cancer committee.
Previously, the starting age was 50 for all men, but there's been a recognition that some men are at increased risk for prostate cancer, especially men who have a positive family history of prostate cancer, so that if you have a brother or a father with prostate cancer, you should have your first PSA at age 45. If you're African-American and you have that same history, you should have it starting at age 40.
What has changed such that people recommend younger ages?
Well, there's been a couple of big studies in the recent past that have shown African-American men tend to fare less well with prostate cancer. What was observed is that African-American men tend to develop prostate cancer three to nine years younger than their counterparts.
So starting at age 50 often put African-American men at a disadvantage because if their disease started at a younger age, they may be at a more advanced stage by the time they were diagnosed. And because of that, they're more likely to succumb to the disease.
Is there any research as to how well black men have been about getting screened in the first place?
There have been a lot of theories about whether black men have adequate access, and whether there may be some cultural reasons or some mistrust of the medical establishment that keeps them from being screened.
But there was a large study just published by the VA hospital in California that showed access to care may not be as big a difference as once was thought.
And that's what leads me to believe that some of the disparity in outcomes may have more to do with a genetic predisposition to get the disease earlier.
Are the PSA levels accurate when it comes to black men?
Well, I think they're measured accurately, but how you interpret the PSA value is different in black men.
If a white man has a PSA of 13.6, that's very high. For most men, the PSA should be less than four. But for a black man who has a PSA of four his risk of prostate cancer is the same as a white man with a PSA of 13.6.
So you can see that a physician who's checking a black man's PSA may say you're fine. Your PSA is only four when, in fact, the risk for that man having cancer is much higher than you would have predicted based on current guidelines for PSA.
What do you do about that?
Well, you start screening at an earlier age, and I think you take very minor elevations or changes in the PSA more seriously.
In African-American men, there's now some additional test called a risk stratification testthat has what's called a high negative predictive value.
For instance, this test has a number. And if you're above that number, you're at increased risk. If you're below that number, there's a 94% chance that you do not have a significant prostate cancer.
And the nice thing about this test is it's a urine test that does not require a digital rectal exam. And I think a lot of the avoidance of being tested for prostate cancer centers around men's dread of that test.
But there are a number of things that you can do to lower your overall risk:
- Keep your weight under control.
- Don't smoke cigarettes.
- Keep your diet low in animal fat.
And by knowing your risk and simply getting an annual examination. I would have the discussion with your physician. But remember this is your body and if you feel like a PSA test is something that would be beneficial for you, then you should feel free to request that of your physician. And if the physician doesn't think you need the test, then let them explain to you why they think you don't need the test.
Dr. Fulgham’s hosting a symposium on prostate cancer Saturday, March 23 at Texas Health Dallas.
RESOURCES:
Experts develop guidelines for prostate cancer screening in Black men
