Screening for Prostate Cancer in African American Men – Judd Moul

Judd Moul reviews the history of the U.S. Preventative Services Task Force screening guidelines and highlights the US trends and patterns of disparities in cancer mortality among U.S. counties from 1980 to 2014. Full Video online at UroToday July 12 2018. Our transcript, August 7 2018, is from the section Moul calls “the bottom line.”

Judd Moul MD
Judd Moul MD

“There have been no randomized trials of prostate cancer screening for black men. The only 2 randomized screening trials (one in Europe, one in the USA) included very few African American men.  And one of the things that really bothers me … Why hasn’t there been … a true randomized trial focusing on African American men, to answer the question … “Is it beneficial to screen for prostate cancer in this high risk group? What is the proper age to initiate screening for African American men? Is it 40, 45, 50, or is it 55? We don’t know that, it’s only speculation.
Slide 6

Backlash against prostate cancer screening

“When the US Preventative Task Force made their dictum against PSA testing, other organizations including American Urological Association chimed in and said community-based free PSA testing clinics are no longer to be used.  They’re supposed to be discouraged, because these community-based free screenings may over-emphasize the positive value of PSA  and not emphasize the negatives.  Or not let patients make a true informed decision.

“And that’s controversial in and of itself, because here we have this high-risk group. In the South-Eastern USA we have this very large African-American community, and we have a high death rate from prostate cancers.

Slide
Map of prostate cancer mortality by county shows concentration of deaths in the South-East region of the USA.

So, again in my opinion, that also needs to be thought about carefully. Is it really wrong to advocate for well-done community-based free screening for prostate cancer in African American men? And that’s, again, in my own opinion, I think screening clinics would not be a bad idea specifically [for] African America men.

“So, I would say in summary that prostate cancer in African American men remains a major public health issue. In my opinion, we should consider periodic testing in this high-risk group.

“However, even if we look at the most-recently released guidelines from the US Preventative Services Task Force, released May 2018, the guidelines do not make specific recommendations for African American men . And the current guidelines would suggest that the only group that should be potentially screened are men between the oges of 55 and 69 . And even in men  of 55 to 69, doctors should carefully explain the pros and cons of PSA testing, and only offer the test to those patients who [are] fully informed  of the pros and cons of PSA.

“In my opinion, the USPSTF should have taken a more nuanced approach to high-risk African American men, and should have recognized potentially there may be a value of testing younger men, say starting at age 45.  And that there may be a value to even offer community-based testing in this high-risk group.”

So, this is the state of the art —  or lack of the state of the art — in mid 2018. I would say, to stay tuned, there’s certainly a lot of opportunities for further research in this area. And finally, I would encourage the prostate cancer research community to think about a randomized control trial, a true prospective randomized trial focused on African American men, potentially in the south-eastern United States, to truly answer the question in this high-risk group, should we screen for this disease in African American men?

Prostate cancer in African-American men remains a major public health issue.”

Judd W Moul, MD, Director, Duke Prostate Center, James H. Semans Professor of Surgery, Duke University, Durham, N.C.