Racial disparities in future development of lethal prostate cancer based on PSA levels in midlife

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Conference Proceeding

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European Urology


Introduction & Objectives: Previous literature has examined prostate cancer (PCa) mortality in a Scandinavian population based on midlife PSA results. The aim of our study was to examine racial disparities in PCa mortality based on midlife PSA results in a North American population.

Materials & Methods: Our cohort included self-identified White and Black men aged 40-59 years, who received their first PSA through our health system between the years 1995 and 2019. Next, patients were divided into 4 categories based on age as follows: 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years. First PSA testing represented the main predictor of interest, and it was categorized based on median and 90th percentile for each age category. Fine-Gray regression was used to examine the impact of the value of PSA at first testing on the risk of developing lethal PCa (i.e. PCa-specific mortality) by race after accounting for all confounders including Charlson comorbidity index among others. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry.

Results: A total of 112,967 men met inclusion criteria during the study period, of whom 82,084 (73%) were White and 30,883 (27%) were Black. Median and 90th percentile PSA were 0.7 and 2.0 ng/ml, respectively, in White men compared to 0.7 and 2.1 ng/ml, respectively, in Black men. For White men aged 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years, median PSA was respectively 0.6, 0.7, 0.7, and 0.9 ng/ml compared to 0.6, 0.7, 0.8, and 0.9 ng/ml in Black men. The 90th percentile PSA in White men was respectively 1.3, 1.6, 2.0, and 2.8 ng/ml compared to 1.4, 1.8, 2.4, and 3.8 ng/ml in Black men. For the same age categories, the estimated rate of lethal PCa at 20 years was significantly higher in Black men when using the 90th percentile PSA cutoff (see Table). Median (IQR) follow-up was 6.7 (2.9 - 14.4) years for White men and 9.9 (4.4 - 16.4) years for Black men. On multivariable analysis, these findings were confirmed.

Conclusions: Our findings suggest that Black men are significantly more likely to develop lethal PCa based on previously published midlife first-time PSA cutoffs. This information suggests that a lower midlife PSA cutoff could be considered amongst Black men. To the best of our knowledge, our report is the first to examine the racial disparities in lethal PCa based on first-time PSA results in a diverse North American cohort.



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