Advancing Diagnostic Excellence and Health Equity

Tailoring Prostate-Specific Antigen (PSA) Screening for Prostate Cancer

Prostate Cancer Disparities

1 IN 8
MEN
IN THE U.S. OVERALL
WILL BE
DIAGNOSED WITH
PROSTATE CANCER
IN THEIR LIFETIME.¹

1 IN 6
BLACK MEN
IN THE U.S. OVERALL
WILL BE
DIAGNOSED WITH
PROSTATE CANCER
IN THEIR LIFETIME.²

Black men are
‍1.8x more likely to
be diagnosed compared
to their White counterparts.^3,4

Black men are
2.1x more
likely to die from
prostate cancer
than their White
counterparts.³

Black men are
44-75%
more likely than
the general
population to
have advanced
disease at the
time of diagnosis.⁵

Prostate Cancer Screening

Since the introduction of Prostate-Specific Antigen (PSA) screening, there has been a 72% reduction in the number of men with metastatic disease at the time of diagnosis.⁶

In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against PSA screening for men of all ages.⁷

In the years immediately following this recommendation, rates of PSA screening decreased, and the diagnosis of advanced prostate cancer increased.⁸

In 2018, the USPSTF recommended that clinicians inform Black men about their increased risk of developing and dying from prostate cancer.⁹

In 2022, only 30% of family physicians report routinely informing Black men of their increased prostate cancer risk.¹⁰

Even though Black men are more than twice as likely to die from prostate cancer, they are screened at lower rates than their White counterparts.

Some studies recommend starting PSA screening
3-9 years earlier
in Black men.⁵

% of men aged 55-69 who had a PSA test within the past year (2005-2021)¹¹

Due to the increased prostate cancer risk, the American Urological Association (AUA) recommends that clinicians offer prostate cancer screening to Black men beginning at
age 40-45.¹²

Risks and Benefits of PSA Screening

The AUA recommends engaging in shared decision-making with people considering prostate cancer screening, so they can make an informed choice.

PSA screening may help to detect cancer early.

Some prostate cancers are slow-growing and unlikely to cause harm (overdiagnosis).

If caught early, it is easier to treat and more likely to be cured.

There can be side effects associated with treatment, and not all prostate cancers require treatment (overtreatment).

Some patients prefer to have more information about their health.

An elevated PSA can be anxiety-provoking for some patients.

Reducing the Harms of Diagnosis and Treatment

Strategies to mitigate the harm associated with unnecessary biopsies and the overdiagnosis and overtreatment of prostate cancer:

Tools to aid in the detection of clinically significant prostate cancer:

Conducting confirmatory PSA tests and using age-specific PSA cutoffs can help reduce the number of unnecessary biopsies.

Prostate magnetic resonance imaging (MRI), prostate cancer risk calculators, other tests, and/or digital rectal exam (DRE) may be used to determine appropriate candidates for biopsy.

Management strategies to prevent overtreatment of prostate cancer:

Active surveillance is the recommended management strategy for low-risk disease. Active surveillance rates in low-risk prostate cancer increased from 27% in 2014 to 60% in 2021.¹³

Watchful waiting is the recommended management strategy for men with asymptomatic prostate cancer and a limited life expectancy.¹⁴

Diagnostic excellence is defined as “an optimal process to attain an accurate and precise explanation about a patient’s condition. An optimal process would be timely, cost-effective, convenient, and understandable to the patient. An accurate and precise diagnosis gains clinical value insofar as it leads to better choices in treatment.”¹⁵ The AUA highlighted “enhancing diagnostic excellence” as a top priority in its National Quality Agenda and Strategies for Urologic Practice, emphasizing its importance in improving urologic health and urologic health care.

For additional information,
visit AUAnet.org

References

American Cancer Society. Key statistics for prostate cancer. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html. Accessed August 20, 2024.
Urology Care Foundation. Early-stage prostate cancer. https://www.urologyhealth.org/educational-resources/early-stage-prostate-cancer. Accessed August 20, 2024.
Bigler SA, Pound CR and Zhou X. A retrospective study on pathologic features and racial disparities in prostate cancer. Prostate Cancer 2011; 2011: 239460.
Tewari A, Horninger W, Pelzer AE et al. Factors contributing to the racial differences in prostate cancer mortality. BJU Int 2005; 96: 1247.
Tsodikov A, Gulati R, De Carvalho TM et al. Is prostate cancer different in black men? Answers from 3 natural history models. Cancer 2017; 123: 2312.
Jain MA, Leslie SW and Sapra A. Prostate cancer screening. https://www.ncbi.nlm.nih.gov/books/NBK556081/. Accessed August 20, 2024.
U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157: 120.
Fleshner K, Carlsson SV and Roobol MJ. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol 2017; 14: 26.
U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. JAMA 2018; 319: 1901.
Shungu N, Diaz VA, Perkins S et al. Physician attitudes and self-reported practices toward prostate cancer screening in Black and White men. Fam Med 2022; 54: 30.
National Cancer Institute. Prostate cancer screening. https://progressreport.cancer.gov/detection/prostate_cancer. Accessed August 20, 2024.
Wei JT, Barocas D, Carlsson S et al. Early detection of prostate cancer: AUA/SUO guideline part I: prostate cancer screening. J Urol 2023; 210:45.
Cooperberg MR, Meeks W, Fang R et al. Time trends and variation in the use of active surveillance for management of low-risk prostate cancer in the US. JAMA Netw Open 2023; 6: e231439.
Eastham JA, Auffenberg GB, Barocas DA et al. Clinically localized prostate cancer: AUA/ASTRO guideline, part I: introduction, risk assessment, staging, and risk-based management. J Urol 2022; 208: 10.
Yang D, Fineberg HV and Cosby K. Diagnostic excellence. JAMA 2021; 326: 1905.

The development of this infographic and algorithm is funded by the Gordon and Betty Moore Foundation and The John A. Hartford Foundation through a grant program administered by the Council of Medical Specialty Societies.