Black Men Less Likely to Get Follow-Up Prostate Cancer MRI

Black, Hispanic and Asian men in the United States are less likely than white men to receive a follow-up MRI after a screening suggests prostate cancer, a new study finds.

The study authors said their results are especially concerning due to the increased risk of prostate cancer in Black men. Previous research has shown that Black people are more likely to get the disease, often get it earlier in life, and are more likely to die from it.

"We can't say definitively if the reason Black, Hispanic, and Asian men did not receive this particular test is that physicians did not refer them for it, or if the patients opted themselves out of further testing," study author Danny Hughes, a professor in the Georgia Tech College of Liberal Arts School of Economics, in Atlanta says.

"Regardless, these disparities do highlight the need to understand what is happening and how to ensure patients of all races and ethnicities receive the best possible care," Hughes says in a university news release.

What the study shows

To assess racial differences in the use of MRI follow-up tests, the researchers analyzed nearly 795,000 insurance claims from 50 states for PSA tests that included laboratory results. They then looked at how many of the men received a follow-up MRI based on varying PSA levels.

A PSA result of 4 ng/mL has long been considered the threshold for recommending prostate biopsy; 2.5 ng/mL is a more recently recognized level for early detection of prostate cancer; and 10 ng/mL is associated with higher rates of biopsies and cancer diagnoses.

Compared to white men, Black men aged 40 to 54 with a PSA above 4 ng/mL were about 40% less likely to get a prostate MRI, while Black men aged 65 to 74 with a PSA above 4 ng/mL were 24% less likely. And Black patients aged 65 to 74 with a PSA above 10 ng/mL were 44% less likely, the findings show.

"We need to understand more about the role of decision-making biases in physicians, as well as other potential factors in the health care system that could account for the disparities we are seeing in this study," Hughes adds.

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What is a prostate screening?

A prostate-specific antigen (PSA) test is a common form of screening for prostate cancer in men aged 55 to 69. Biopsies have been the usual next step for some men with elevated PSA levels that suggest prostate cancer, but non-invasive MRIs are increasingly being used instead.

Risks and benefits of prostate screening

There have been conversations about the risks and benefits of prostate screenings, but ultimately the biggest benefit of prostate screenings is early detection. Early detection gives you a better opportunity to cure the disease if treatments are needed. It also allows you the

opportunity to monitor the progression of the cancer if it is slow-growing instead of getting immediate treatment, which can cause serious side effects and long-term complications.

There are no inherent risks related to screening, but it is important to consider timing when thinking about getting a screening.

Should you get screened?

PSA screening decisions should be made on a case-by-case basis between you and your doctor. However, because prostate cancer is genetic, you should begin discussing screening with your doctor at 40 if you are Black or have a family history of prostate cancer.

What to expect from a screening

A PSA will reveal results that will help you and your doctor determine your next steps. For example, if your PSA is elevated, your doctor may recommend a biopsy where tissue will be removed to determine if you have prostate cancer.

There are also many other supplementary tests and considerations that can help you and your doctor decide if a biopsy is necessary, including:

Digital rectal exam results
Free PSA test (<10% Free PSA indicates greater risk of having cancer; <25% is concerning)
PSA velocity or the rate of rise over time (faster increase means more risk)
PSA density, or the PSA per volume of prostate (higher density means more risk)
PSA-based markers (e.g., the Prostate Health Index or 4K score)
Other markers, a urinary PCA3 or SelectMDx test
Magnetic resonance imaging (MRI) of the prostate

You should discuss these tests with your doctor in order to make a decision that is best for you.

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After a diagnosis of prostate cancer is confirmed, PSA will still be used for monitoring the status of your cancer. The results will depend on how the cancer is managed.

The decision of whether or not you should get a screening will be a tough one, but with the appropriate discussion with your doctor; you will be able to make an informed decision that works for you.

When talking with your doctor remember to discuss the following: