PHEN: How Black Men Can Survive Prostate Cancer
African American men suffer the highest prostate cancer incidence and mortality rates among men of all racial and ethnic backgrounds in the United States. This racial disparity is the largest for any major cancer and all African American men are deemed to be at high – risk for prostate cancer. The United States Senate passed a resolution in 2012 recognizing prostate cancer among African American men to be of epidemic proportions.
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Recent guideline statements and recommendations regarding the use of prostate – specific antigen (PSA) testing for the early detection of prostate cancer, and the resulting controversy, have led to confusion and a lack of clarity for the men most at risk for suffering and dying from prostate cancer.
Despite high-level evidence for the use of PSA testing as an aid to early prostate cancer detection, and also for its role as a predictor of future risk, the U.S. Preventive Services Task Force (USPSTF) has called for PSA testing to be abandoned completely. The American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) support a role for PSA testing but with somewhat conflicting recommendations. The guideline statements have endorsed the role of shared decision-making for men considering PSA testing. However, media reports on the PSA test controversy are confusing and preventing many African American men from even having a discussion with physicians about early detection, thereby negating any opportunity for shared decision-making, and in the absence of discussion most men do not have PSA testing.
African American men and certain other men deemed to be at high – risk for prostate cancer, including men with a family history and men exposed to agent orange , were not included in sufficient numbers in the two main randomized clinical trials  used as the scientific evidence to formulate the PSA test guidelines. Few men, if any, of African ancestry and obviously no African Americans were included in the European trial. Consequently, some guidelines do not directly or clearly address the needs of African American men.