Black Men Have Higher Risk of Prostate Cancer Than White Men at the Same PSA Levels

While it’s well established that Black men in the United States are more likely to develop prostate cancer and die of it than white men, a new study shows that Black males are also more likely to have prostate cancer at any PSA level.

Prostate-specific antigen (PSA) is a protein made by the prostate (a male sex gland), and levels can be higher in the blood of men who develop prostate cancer. This latest research indicates that Black men may face an increased risk of prostate cancer even at lower PSA levels than white men.

“We know Black men are at higher risk, but our study puts a number to that in terms of PSA value,” says Julie Lynch, PhD, RN, an author of the study and the director of the precision medicine research team for VA Informatics and Computing Infrastructure (VINCI), a national resource center for the Department of Veterans Affairs (VA). “What was compelling to me was that a PSA of 4 in Black men is equivalent to a PSA of 13.4 in white men.”

A High Cancer Risk at Lower PSA Levels

The scientific paper, published November 6 in Cancer, a journal of the American Cancer Society, also highlighted that Black men with a pre-biopsy PSA of 4.0 ng/mL had a 49 percent risk of prostate cancer detected during their biopsy, compared with a 39 percent risk for white men with the same PSA level.

The American Cancer Society says that PSA levels often go above 4 when prostate cancer develops. Men with a PSA level between 4 and 10 are considered “borderline” and have about a 1 in 4 chance of having cancer.

Drawing on health data from about 75,000 Black and 208,000 white male veterans, Dr. Lynch and her colleagues further noted that prostate cancer was detected in the first prostate biopsy in 55 percent of Black men, compared with 43 percent of white men. The median age for the first biopsy was 63 for Black men and 65 for white men.

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After various competing factors were taken into account, Black veterans were found to have a 50 percent greater chance of a prostate cancer diagnosis from their first prostate biopsy than white veterans.

Black men also had 30 percent greater odds of clinically significant aggressive prostate cancer.

“That’s important, because you really have to treat aggressive cancer or you will die of it,” says Lynch. “You don’t want to overtreat, but there’s a risk of undertreating, particularly with Black men.”

A Call to Address Racial Disparities

An analysis published in 2022 estimated that Black men had about an 80 percent higher risk of prostate cancer and a 220 percent greater risk of death from it than white men.

For Lorelei Mucci, ScD, MPH, a professor of epidemiology with the Harvard T.H. Chan School of Public Health and the director of strategic research partnerships at the American Cancer Society, the research spotlights the urgent need to address the underlying racial disparities in prostate cancer and to better understand why PSA values indicating prostate cancer differ in Black and white men.

“Black men carry an undue burden of prostate cancer,” says Dr. Mucci, who was not involved in the research. “The study calls out the importance of a possible lower threshold for biopsy in Black men, while also potentially diagnosing cancers earlier when cure is still possible.”

In an effort to address the disparities and negative trends in prostate cancer incidence, Mucci and her collaborators at the American Cancer Society are working on a new initiative called IMPACT, or Improving Mortality Toward Prostate Cancer Together.

It’s Lynch’s hope that this latest data will empower patients to better evaluate their risk and make more informed decisions about PSA testing in discussion with their primary care provider.

If you’re a Black man and your father or grandfather developed prostate cancer early, or died of it, she advises having early discussions with your primary care provider about whether PSA screenings at a younger age and more frequently is a good idea.

“This study illustrates how important it is for clinical guidelines to be informed by research conducted within diverse patient populations,” says Lynch. “Thanks to advances in precision medicine, we now understand that cancer screenings should be informed by an individual patient’s characteristics — including age, ancestry, family history of cancer, smoking history, other exposures, and perhaps even their genetic risk score for cancer.”

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