In the U.S., Black men are at higher risk of being diagnosed with, and dying from prostate cancer than men of other races. Data suggests that they are diagnosed with prostate cancer between 3-9 years earlier than other men and are two times more likely to die from the disease than white men.
Guidelines for all men currently suggest getting an initial test for prostate cancer between the ages of 50 and 55, but according to the new guidelines, Black men should consider getting a test when they are between 40 and 45 years old.
“We don’t know what causes prostate cancer,” said Dr. William Oh, Chief Medical Officer at the Prostate Cancer Foundation. “We know it is a disease of aging, we know that there are some environmental factors and we know that it tends to run in families. But, we don’t currently know why Black men are higher-risk for being diagnosed with prostate cancer than other men,” added Dr. Oh.
The guidelines were formed by an advisory board of physicians and patients and involved reviewing available evidence including trials and scientific studies to extract any relevant data on prostate cancer in Black men. These are not the first time that it has been recommended that Black men get tested earlier, but as Dr. Oh explains, with other guidelines this was often a footnote rather than the main aim of the work.
“We wanted to put these guidelines out there in a very clear and distinct way. So that so the message was not lost in an asterisk and that it’s basically as clear as possible for the population and the man and his family who are reading about these recommendations,” said Dr. Oh.
Testing typically involves looking for levels of Prostate Serum Antigen (PSA) and although the consensus is that the test has saved many lives by detecting cancers early and enabling treatment, there is also some controversy surrounding it when used for screening men who don’t have any symptoms of prostate cancer.
“The PSA test is clearly the single best way to identify prostate cancer early, but it does have flaws,” said Dr. Oh.
PSA testing can provide false-positive results, leading to invasive and costly testing for no reason. It also is unable to detect the difference between aggressive disease that may require urgent treatment and non-aggressive cancer, which may require no treatment at all or a “watch and wait” approach.
“There is a balancing act is of identifying too many clinically insignificant cancers versus finding the ones that might be dangerous and, and even fatal if you find them too late,” said Dr. Oh.
If implemented widely, the new guidelines could reduce deaths from prostate cancer in Black men by almost a third, according to the Prostate Cancer Foundation.