PSA Screening for the African American Male: When and Why?

Abstract

Prostate cancer is the second-leading cause of cancer death in American men. Prostate cancer diagnosis and mortality differences between African American and Caucasian populations have been highlighted in the literature. Research has shown that African American males are at a biological predisposition for prostate cancer and that additional socioeconomic and physician-patient educational factors may contribute to the higher mortality rate among this group—over two times greater than that of Caucasian American males. The United States Preventive Services Task Force (USPSTF) recently concluded that there is insufficient evidence on the harms and benefits of prostate-specific antigen (PSA) screening to recommend that anyone should receive the test. However, the American Urological Association (AUA) emphasizes that the value of early detection should not be overlooked and that shared decision making should be integral to screening decisions. Parameters that can be used concurrently with PSA measurements have been proposed and implemented in an attempt to more accurately determine individualized prostate cancer risk and minimize undue treatment. The AUA urges individuals to personally assess, with their physicians, whether a PSA screen is necessary. Emphasis should be placed on the proper education of African American men who are at increased risk for the disease, as well as on their participation in repeated screening practices for the earliest possible detection of prostate cancer.