MidLife PSA can stratify the risk of prostate cancer in African-American men

MedicalResearch.com Interview with:

Mark Preston, MD, MPH
Associate Surgeon, Brigham and Women's Hospital
Assistant Professor of Surgery, Harvard Medical School
Brigham and Women's Hospital
Department of Surgery, Urology
Boston, MA
MedicalResearch.com: What is the context of this study? What are the main results?

Reply: Black men have a significantly increased risk of developing and dying from prostate cancer. Unfortunately, research on screening strategies in this high-risk population is limited. In this initial study, we studied how baseline PSA levels measured at midlife predicted a subsequent risk of aggressive prostate cancer in a black male population. This study used stored blood samples and more than a decade of follow-up in the Southern Community Cohort Study, an ongoing cohort study with the highest representation of black men in the United States.

We have shown that levels of PSA in the forties predicted very strongly the future aggressive cancer of the prostate. Our data identify subgroups of black men who present a highly variable long-term risk of aggressive prostate cancer, based on the initial PSA in mid-life. We suggest that these groups can benefit from screening intervals tailored to the true magnitude of the disease risk.

These important findings build on our previous work on baseline PSA and the risk of fatal prostate cancer in predominantly white men, published in the Journal of Clinical Oncology in August 2016.

MedicalResearch.com: What should the readers of your report keep?

Reply: One strategy to improve PSA screening is to perform an earlier measurement of PSA in the 40s to 40s. Our group and others have shown that PSA levels during midlife strongly predicted the long-term risk of prostate cancer, particularly the risk of aggressive disease, in both black men and white men .

This baseline PSA level at midlife can be used to stratify the risk of PSA screening, targeting men at higher risk for screening in order to diagnose and treat them early, as long as it is possible to heal. In addition, low-risk men could be screened safely less often. As a result, much of the benefit of PSA testing for prostate cancer mortality could be maintained, while overdiagnosis and over-treatment would be reduced.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Reply: Prospective studies of a stratified risk-based screening program should be conducted. We are also exploring ways to further improve risk prediction and to explore the biological mechanisms that explain why a mid-life PSA is so predictive.

Disclosures. I have no disclosure. Disclosures concerning other authors are listed in the manuscript.

Quote:

Eur Urol. Sept. 17, 2018: S0302-2838 (18) 30627-4. doi: 10.1016 / j.eururo.2018.08.032. [Epub ahead of print]

Initial level of prostate-specific antigen in aggressive and persistent prostate cancer in black men.

Preston MA¹, Gerke T², Carlsson SV³, Signorello L⁴, Sjoberg DD⁵, Markt SC⁶, Kibel AS⁷, Trinh QD⁷, Steinwandel M⁸Spot W⁹, Vickers AJ⁵Lilja H^ten, Mucci LA⁶, Wilson KM¹¹.

October 14, 2018 at 12:36 pm

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