SUMMARY: Prostate cancer is the most common cancer in American men with the exclusion of skin cancer, and 1 in 8 men will be diagnosed with Prostate cancer during their lifetime. It is estimated that in the United States, about 299,010 new cases of Prostate cancer will be diagnosed in 2024 and 32,250 men will die of the disease. There are however significant racial disparities, and for Black men, 1 in 6 will develop prostate cancer and are more than twice likely, to die from the disease. Black men are more likely to be diagnosed with prostate cancer at a younger age and with more aggressive disease. Nonetheless, there are very few guidelines that have outlined specific recommendations for Prostate Specific Antigen (PSA)-based prostate cancer screening among Black men.
A multidisciplinary panel of experts in Primary Care, Urology, Medical and Radiation Oncology conducted a comprehensive literature search in PubMed and Embase and after reviewing 265 relevant studies, developed six new guideline statements addressing screening for Black men, reaching a consensus, with 80% or higher agreement rate among these experts.
Prostate Cancer Foundation (PCF) Statements of Recommendations
Question 1. Should Black men be screened for prostate cancer?
Yes. Since Black men are at a high risk for prostate cancer, the benefits of screening generally outweigh the risks.
Question 2. What should Black men know about how screening for prostate cancer is conducted?
Prostate-Specific-Antigen (PSA) is a blood test that should be considered first-line for prostate cancer screening. Some providers may recommend an optional Digital Rectal Exam (DRE) in addition to the PSA test.
Question 3. What information should Black men obtain to make an informed decision about PSA screening and early detection of prostate cancer?
Decisions about PSA testing depend on individual preferences. Black men should engage in shared decision-making with their health care providers and other trusted sources of information to learn about the pros and cons of screening.
Question 4. When should Black men obtain their first PSA test and how often should they be screened for prostate cancer?
For Black men who elect screening, a baseline PSA test should be done between ages 40 and 45. Depending on the PSA value and the individuals health status, annual PSA screening should be strongly considered.
Question 5. At what age should Black men consider stopping PSA screening?
Black men over the age of 70 who have been undergoing prostate cancer screening should talk with their health care provider about whether to continue PSA testing and make an informed decision based on their age, life expectancy, health status, family history, and prior PSA levels.
Question 6. How should family history and genetic risk be taken into consideration when screening Black men for prostate cancer?
Black men who are at even higher risk due to a strong family history and/or known carriers of high-risk genetic variants should consider initiating annual PSA screening as early as age 40.
The PCF expert panel concluded that based on the best available evidence, risk-adapted PSA screening in US Black men can reduce the rate of metastasis and death from prostate cancer. They added that although additional studies can elucidate the impact of PSA screening on Black men, based on the current evidence, other national guideline groups should consider revising current recommendations for early prostate cancer detection in Black men.
Prostate Cancer Foundation (PCF) screening guidelines for prostate cancer in Black men in the United States. Garraway I, Carlsson SV, Nyame YA, et al. https://doi.org/10.1200/JCO.2024.42.4_suppl.264
