Midlife baseline PSA as a predictor of lethal prostate cancer: Racial differences between black and white men

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Most previous reports have examined prostate cancer (PCa) mortality in homogenous populations based on midlife baseline PSA (MB PSA), defined as the first PSA test performed between 40 and 59 years old. Our study aims to investigate racial disparities in the predictive value of MB PSA for lethal PCa, defined as death from PCa or the development of metastatic disease either at diagnosis or during follow-up, in a diverse, contemporary, North American population. Materials & Methods: Our cohort included White and Black men aged 40-59 years, who underwent MB PSA through our health system between 1995 and 2019. Patients were divided into 4 categories based on age: 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years. MB PSA testing during the study period represented the main predictor of interest, and it was categorized based on PSA above/below the median in the entire cohort and for each age group. Multivariable Fine-Gray regression (MVA) was used to examine the impact of the MB PSA in predicting lethal PCa by race, after accounting for all confounders including the Charlson comorbidity index among others. Results: A total of 112,967 men met the inclusion criteria, of whom 82,084 (73%) were White and 30,883 (27%) were Black. White patients had their first PSA most frequently in the 50–54 age group (33.9%) while Black patients at 40-44 (27.6%). The rate of PCa diagnosis was 7.0% in Black patients vs. 3.9% in White patients, and lethal PCa was 1.2% vs 0.6%, respectively (both p<0.0001). White patients harbored more frequent Gleason score 3+3 disease (23.7% vs 16.0%), and less frequent cM+ (12.7% vs. 15.2%) than Black patients (both p<0.05). Median follow-up was 6.7 (IQR 2.9 - 14.4) years for White patients and 9.9 (4.4 - 16.4) years for Black patients. At MVA, using White patients with PSA≤median as the reference group, the HR of lethal PCa for White men with PSA>median aged 40-44, 45-49, 50-54, and 55-59 was respectively 2.98 (1.59-5.57), 3.01 (1.89-4.81), 5.10 (3.38-7.70) and 3.38 (2.32-4.92). While the HR of lethal PCa for Black men with PSA>median aged 40-44, 45-49, 50-54 and 55-59 was respectively 5.50 (2.94-10.27), 4.19 (2.59-6.78), 9.79 (6.37-15.04) and 7.53 (5.03- 11.26) (all p < 0.001). Conclusions: Our findings indicate that for the same MB PSA and within the same age category, Black men have almost double the risk of developing lethal PCa than White men. This implies that separate and different cut-offs should be created for MB PSA, if this is to be used to guide PSA screening in clinical practice.

Volume

85

First Page

S54

Last Page

S54

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