Letters to the Editor

African American men: caught in the middle of prostate cancer screening controversy

Prostate cancer is the leading form of cancer in men in the United States, with over 240,000 men diagnosed and 30,000 thousand dying from it each year. For reasons that are not completely understood, African American men have the highest rates of prostate cancer in the U.S., as 1 in 5 will get prostate cancer in their lifetime.

African Americans are also 60 percent more likely to be diagnosed with prostate cancer and 2.5 times likely to die of the disease.

When caught early, prostate cancer can be treated, usually successfully. But because many men experience no symptoms, it is often identified only by an abnormal result on a basic prostate cancer screening called the PSA test. The PSA test is a blood test that measures prostate-specific antigen (PSA), a protein produced by the prostate gland. An increase in the PSA level is often the only sign of early prostate cancer.

The PSA test is also valuable in monitoring patients after treatment. In May 2012, despite tremendous opposition, a U.S. Preventative Services Task Force (USPSTF) Committee announced a recommendation that PSA testing should no longer be performed routinely on men in the United States.     

One of the major concerns raised by opponents of the recommendation is that the studies that were cited lacked representation of African American participants. Thus, their results may not be applicable to that group of men.  

The USPSTF committee also failed to acknowledge the impact of screening on declining cancer death rates. Opponents of this recommendation argued that fewer men are dying of prostate cancer and it is very likely that early detection has played a role in this outcome.

Despite the decrease in death rates, African American men continue to carry a disproportionately higher death rate and, among men under the age of 60, are 4 times more likely to have metastatic disease at diagnosis.

There is now ongoing research to find better screening strategies than the PSA test. However, until these tests have been confirmed, the PSA test continues to be an important part of early detection.

Any man that is over 40 years of age should have meaningful dialogue with his healthcare provider to understand the details of the PSA test, its value, and possible shortcomings.

If you are diagnosed with prostate cancer, consider all options for treatment before making a decision or, if the cancer is not aggressive, talk to your doctor about active surveillance. As with any illness, make sure you get a second opinion before proceeding with any post-diagnosis path.