Baseline PSA Levels Critical for Men of African Descent

Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men. Targeted screening based on a midlife PSA might identify men at high risk while minimizing screening in those men at low risk.¹

Men of African descent, particularly Caribbean men and African Americans, are at a higher risk of lethal prostate cancer as well as survivable prostate cancer.  Yet screening rates for persons of african descent are in decline, particularly in the Caribbean and the United States.  According to Qian Et. Al., "PSA screening among younger men steadily decreased over the past decade since the 2012 United States Preventive Services Task Force guidelines, demonstrating a narrowing racial gap. How such an observed trend translates to long-term clinical outcomes for younger Black men remains to be seen."² 

Those same guidelines, and the subsequent 2016 revision, carve out African Americans as persons of high risk, while not offering advice on screening age, baseline scores, or acknowledge a person of African descent is far less likely than his/her white counterpart.³ Yet studies show that African Americans would benefit most from baseline testing and subsequent testing based on their intial findings.  Specifically, Randazzo Et. Al. noted, "We observed men with a prostate-specific antigen (PSA) value ≤3 ng/ml during 12 yr and found that men can be retested according to their initial PSA value ("PSA pyramid"): PSA <1 (base), retest interval every 8 yr; PSA 1-2 (center), retest interval every 4 yr; and PSA 2-3 (top), retest yearly after risk stratification."⁴

While best practices are based on age and ethnicity stratifications, it's noted that PSA levels in midlife strongly predicted total and aggressive PCa among black men. PSA levels among controls were similar to those among white controls in prior studies.²

While screening rates are in decline, and mortality and morbidity are on the rise in persons of African descent, it's important to remember that PSA levels are as individual as we collectively are.  If you're a black man between 40-45, get screened,  because Prostate-specific antigen (PSA) level during midlife strongly predicted future development of aggressive prostate cancer among black men.

¹Preston MA, Gerke T, Carlsson SV, Signorello L, Sjoberg DD, Markt SC, Kibel AS, Trinh QD, Steinwandel M, Blot W, Vickers AJ, Lilja H, Mucci LA, Wilson KM. Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men. Eur Urol. 2019 Mar;75(3):399-407. doi: 10.1016/j.eururo.2018.08.032. Epub 2018 Sep 17. PMID: 30237027; PMCID: PMC6390280.

²Qian Z, Al Khatib K, Chen X, Belani S, Labban M, Lipsitz S, Cole AP, Iyer HS, Trinh QD. Investigating the racial gap in prostate cancer screening with prostate-specific antigen among younger men from 2012 to 2020. JNCI Cancer Spectr. 2023 Mar 1;7(2):pkad003. doi: 10.1093/jncics/pkad003. PMID: 36708009; PMCID: PMC9991604.

³Franks P, Fiscella K, Meldrum S. Racial disparities in the content of primary care office visits. J Gen Intern Med. 2005 Jul;20(7):599-603. doi: 10.1111/j.1525-1497.2005.0109.x. PMID: 16050853; PMCID: PMC1490148.

⁴Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Chun FK, Recker F, Kwiatkowski M. A "PSA pyramid" for men with initial prostate-specific antigen ≤3 ng/ml: a plea for individualized prostate cancer screening. Eur Urol. 2015 Oct;68(4):591-7. doi: 10.1016/j.eururo.2014.04.005. Epub 2014 Apr 18. PMID: 24794075.