NMA Statement On New Prostate Cancer Screening Guidelines

Healthy young black man(BlackDoctor.org) — Prostate cancer continues to pose a significant health concern in the United States. It is estimated that 240,890 American men will be diagnosed with prostate cancer in 2011. Additionally, approximately 33,720 men are expected to succumb to this disease. It is second only to lung cancer in cancer-related deaths.

Significant racial disparities exist for African American men diagnosed with prostate cancer. In fact, African American men have a 60% higher incidence of the disease and 2-fold higher mortality compared to other ethnic groups in the United States. Efforts at early detection of the disease are particularly critical in African American men as they are approximately 3-4 times more likely to present with distant and incurable cancer than Caucasian men.

Recently, there have been concerns that PSA screening results in over diagnosis and overtreatment of prostate cancer along with harmful effects to patients. Recommendations have been made by a federal panel to limit the use of PSA as a screening test. These recommendations are primarily based on observations from large clinical studies performed in Europe, Canada, and the United States; very few African American men participated in these studies. As a result, the findings of these studies may not be appropriate for the African American community.

Since PSA testing was initiated, a clear trend toward declining mortality rates among prostate cancer patients has been observed. Although PSA screening cannot readily separate aggressive from indolent cancers, it currently represents the best method to detect early stage, curable prostate cancers. The R. Frank Jones Urological Society and the Urology section of the NMA therefore support the use of PSA in the early detection of prostate cancer as a means to support health promotion in African American men. Moreover, we endorse the American Urologic Association’s best practice statement on prostate cancer early detection, which includes:

1. Initial PSA testing at 40 years of age
2. Both DRE and PSA as part of screening
3. An informed decision making process
4. A multi-factorial assessment of risk based on age, ethnicity, family history, PSA kinetics and density.

In keeping with the NMA’s mission, the Urology Section also strongly supports a community based approach to early detection of prostate cancer that features education, improved access, and patient-provider dialogue, as well as the promotion of health seeking behavior in underserved populations.