Black Patients Have Higher Risk of Prostate Cancer at Younger Ages, Lower PSA Levels

Black men have a higher risk of prostate cancer at younger ages and lower prostate-specific antigen (PSA) levels than White men, according to research published in Cancer.

Researchers found that Black patients were more likely than White patients to be diagnosed with prostate cancer on their first biopsy, and the likelihood of prostate cancer detection was consistently higher among Black patients.

This study included 75,728 self-identified Black men and 208,663 self-identified White men from the Veterans Health Administration.

Black patients received their first PSA test 5 years earlier than White patients. The median age at the first test was 56 years and 61 years, respectively. Black patients also had their first prostate biopsy 2 years earlier than White patients. The median age at first biopsy was 63 years and 65 years, respectively.

In addition, Black patients had a higher median prebiopsy PSA level than White patients — 6.2 ng/mL and 5.8 ng/mL, respectively (P <.001).

After controlling for baseline variables, including PSA level and smoking status, Black patients were more likely than White patients to be diagnosed with prostate cancer on their first biopsy (odds ratio [OR], 1.498; 95% CI, 1.470-1.526; P <.001).

The difference in risk between Black and White patients was more pronounced among patients who were 60 years of age or younger (OR, 1.823; 95% CI, 1.765‐1.883) than among patients aged 61 to 70 years (OR, 1.439; 95% CI, 1.401‐1.477) or among patients older than 70 years of age (OR, 1.171; 95% CI, 1.121‐1.224; P <.001).

The researchers also noted that the likelihood of prostate cancer detection among Black patients was consistently higher than that of White patients over the prebiopsy PSA range of 2.0 ng/mL to 20.0 ng/mL. For instance, the data suggested that a Black patient with a prebiopsy PSA level of 4.0 ng/mL and a White patient with a PSA level of 13.4 ng/mL have an equivalent risk of prostate cancer.

The researchers also found that Black patients were more likely than White patients to be diagnosed with aggressive prostate cancer (OR, 1.306; 95% CI, 1.275‐1.338; P <.001).

These findings suggest that “at any given PSA level, Black men have substantially higher risk of prostate cancer detection on their first biopsy compared with White men after accounting for socioeconomic factors, age, and prebiopsy PSA,” the researchers wrote. “Combined with population‐level data suggesting both earlier onset and higher incidence of prostate cancer in Black men, our findings may indicate a need for PSA biopsy thresholds to be informed by a better understanding of patient risk factors.”

Reference

Lee KM, Bryant AK, Lynch JA, et al. Association between prediagnostic PSA and prostate cancer probability in Black and non‐Hispanic White men. Cancer. Published online November 6, 2023. doi:10.1002/cncr.34979

This article originally appeared on Cancer Therapy Advisor