DETECTION of prostate cancer at first biopsy, and likelihood of prostate cancer detection, has been discovered to be consistently higher in Black patients compared to their White counterparts. Research has concluded that Black males have a higher risk of prostate cancer, and lower prostate-specific antigen (PSA) levels at young ages.
The current research included 75,728 self-identified Black males, and 208,663 self-identified White males, with a median age at first biopsy of 63 years and 65 years, respectively. Black patients received their first PSA test 5 years earlier than White patients, and the median age at first test was 56 years and 61 years, respectively. Black patients also had a higher median pre-biopsy PSA level than White patients, at 6.2 ng/mL versus 5.8 ng/mL (p<0.001).
After controlling for baseline variables, including PSA level and smoking status, Black patients were more likely than White patients to be diagnosed with prostate cancer at their first biopsy (odds ratio [OR:] 1.498; 95% confidence interval [CI]: 1.470–1.526; p<0.001). The difference in risk between Black and White patients was more pronounced in populations under the age of 60 (OR: 1.823; 95% CI: 1.765–1.883), compared with those aged 61–70 years (OR: 1.439; 95% CI: 1.401–1.477), or among those older than 70 years (OR: 1.171; 95% CI: 1.121–1.224; p<0.001). The researchers also noted that the likelihood of prostate cancer detection among Black patients was consistently higher than that of White patients over the pre-biopsy PSA range of 2.0 ng/mL to 20.0 ng/mL, and that Black patients were more likely to be diagnosed with aggressive prostate cancer (OR: 1.306; 95% CI: 1.275–1.338; p<0.001).
Accounting for socioeconomic factors, age, and pre-biopsy PSA, the researchers were able to conclude that Black patients have a significantly higher risk of prostate cancer detection at first biopsy. These findings indicate a need for PSA biopsy thresholds to be informed by superior understanding of patient risk factors, and are likely to raise awareness for screening initiatives in males.
