Evaluating Prostate-Specific Antigen Screening for Young African American Men With Cancer
© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissionsoup.com..
BACKGROUND: Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients.
METHODS: We identified African American men aged 40-55 years, diagnosed with prostate cancer between 2004 and 2017 within the Veterans Health Administration. Inverse probability of treatment-weighted propensity scores were used in multivariable models to assess PSA screening on PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on prostate cancer-specific mortality (PCSM), with noncancer death as competing events. All statistical tests were 2-sided.
RESULTS: The cohort included 4726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1057 (22.4%) with no PSA screening prior to diagnosis. Compared with no screening, PSA screening was associated with statistically significantly reduced odds of PSA levels higher than 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49 to 0.63; P < .001), Gleason score of 8 or higher (OR = 0.78, 95% CI = 0.69 to 0.88; P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39 to 0.64; P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36 to 0.76; P < .001). Primary care provider visits displayed similar effects.
CONCLUSIONS: Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:114 |
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| Enthalten in: |
Journal of the National Cancer Institute - 114(2022), 4 vom: 11. Apr., Seite 592-599 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Qiao, Edmund M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 13.04.2022 Date Revised 24.02.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/jnci/djab221 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM334303591 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients | ||
| 520 | |a METHODS: We identified African American men aged 40-55 years, diagnosed with prostate cancer between 2004 and 2017 within the Veterans Health Administration. Inverse probability of treatment-weighted propensity scores were used in multivariable models to assess PSA screening on PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on prostate cancer-specific mortality (PCSM), with noncancer death as competing events. All statistical tests were 2-sided | ||
| 520 | |a RESULTS: The cohort included 4726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1057 (22.4%) with no PSA screening prior to diagnosis. Compared with no screening, PSA screening was associated with statistically significantly reduced odds of PSA levels higher than 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49 to 0.63; P < .001), Gleason score of 8 or higher (OR = 0.78, 95% CI = 0.69 to 0.88; P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39 to 0.64; P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36 to 0.76; P < .001). Primary care provider visits displayed similar effects | ||
| 520 | |a CONCLUSIONS: Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Lynch, Julie A |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Kyung M |e verfasserin |4 aut | |
| 700 | 1 | |a Kotha, Nikhil V |e verfasserin |4 aut | |
| 700 | 1 | |a Nalawade, Vinit |e verfasserin |4 aut | |
| 700 | 1 | |a Voora, Rohith S |e verfasserin |4 aut | |
| 700 | 1 | |a Qian, Alexander S |e verfasserin |4 aut | |
| 700 | 1 | |a Nelson, Tyler J |e verfasserin |4 aut | |
| 700 | 1 | |a Yamoah, Kosj |e verfasserin |4 aut | |
| 700 | 1 | |a Garraway, Isla P |e verfasserin |4 aut | |
| 700 | 1 | |a Stewart, Tyler F |e verfasserin |4 aut | |
| 700 | 1 | |a Parsons, J Kellogg |e verfasserin |4 aut | |
| 700 | 1 | |a Rose, Brent S |e verfasserin |4 aut | |
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