New hurdle seen to prostate screening: primary-care docs

(Press-News.org) Although Black men die of prostate cancer at twice the rate of the rest of U.S. males, this fact often is not known or considered during appointments with their primary-care clinicians to discuss a common screening test.  

The new qualitative study published this week in JAMA Network Open showed that Black men often view their primary-care providers as the gatekeepers to receiving a prostate specific antigen (PSA) test, which is the first step to screening for prostate cancer. 

“There is an often-used phrase, ‘Prostate cancer is a cancer one dies with; it’s not a disease you die from,’” said the study’s lead author, Jenney Lee, a senior research scientist in urology at the University of Washington School of Medicine. 

“And to a point that is true in that, in many cases, prostate cancer is slow growing.” 

But the 29 Black men interviewed for this study related that, in many instances, their providers dismissed the PSA test as unnecessary and did not have the background knowledge that Black men are highly at risk for this type of cancer.  

Black men also tend to be diagnosed at an earlier age, and at a later stage of disease than other men.  

“Which is why we are focused on PSA screening to catch the disease earlier, when it is more treatable,” Lee said. 

“This is why these conversations (about PSA testing) really need to be happening,” she said. “If we can get Black men screened in their 40s rather than in their 50s, the mortality rate due to prostate cancer drops by up to 30%.” 

The incidence of prostate cancer among Black men in the United States is 60% to 80% higher than in men of other races. Their mortality rate is twice that of non-Black men. 

Interview participants, all in the Puget Sound region of Washington state, reported a lack of trusted relationships with their primary-care clinician to support shared decision-making.  

While both urologists and primary-care professionals were highly aware of U.S. Preventive Services Take Force guidelines, those in primary-care were much less likely than urologists to believe in the value of PSA testing or the role of early detection to prevent prostate-cancer related mortality, the study authors noted.  

In fact, only 6% of the primary-care clinicians said in their surveys that they considered PSA testing as playing a significant role in reducing prostate cancer mortality, authors noted.  

“That lower percentage surprised us,” Lee said.   

Aside from patient interviews, the study authors sent online surveys to 63 physicians and urologists in the Pacific Northwest and Alaska. The study was conducted between Sept. 1, 2021, and Dec. 31, 2023.  

To be fair, primary-care professionals have received mixed messages about prostate cancer and the value of PSA tests, Lee said.  The U.S. Preventive Services Task Force (USPSTF) ranks the test as a “C,” or recommended in some cases. And it has no rating that specifically focuses on high-risk groups, such as Black men, according to its website.  

In contrast, the American Urological Association recommends a 2- to 4-year screening interval for men ages 50 to 69 with average risk. Screening may be offered to high-risk men, which includes Black men, beginning at ages 40 to 50, according to the association’s website.  

The American Cancer Society recommends that Black men start conversations about prostate cancer screening, including PSA testing, at age 45, or 40 if there's a family history of cancer. 

Dr. Yaw Nyame, UW Medicine urologist and senior author of the study, hopes that the USPSTF might upgrade its recommendation or make a specific recommendation for underserved communities such as Black men. Nyame is also a physician at the Fred Hutch Cancer Center.   

The site acknowledges that an update to the guidance is pending.  

“This paper shows that we are not applying this lens to Black patients as much as we should,” Nyame said. “Healthy Black males should have a screening if they wish. 

In our study, we found that this request was often met with resistance, that the primary- care providers didn’t believe in PSA testing,” he added. “In bigger picture, we need to revisit how we view prostate-cancer screening in these communities.” 

Lee suggested that primary-care providers might shy away from recommending a PSA test for fear of a false positive result, which might lead to more expensive and invasive testing. But given the highly at-risk nature of Black patients, this caution may need to be set aside, she said  

“We know this is a hot button issue in many medical communities. But this is a discussion that needs to be had.” 

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